K. Ralovich, L. Itu, D. Vitanovski, P. Sharma, Razvan Ioan Ionasec, V. Mihalef, W. Krawtschuk, Yefeng Zheng, A. Everett, G. Pongiglione, B. Leonardi, R. Ringel, N. Navab, T. Heimann, D. Comaniciu Non-invasive Hemodynamic Assessment, Treatment Outcome Prediction and Follow-up of Aortic Coarctation from MR Imaging Medical Physics Journal (bib)
	{\bf Purpose:} Coarctation of the aorta (CoA?) is a congenital heart disease characterized by an abnormal narrowing of the proximal descending aorta. Severity of this pathology is quantified by the blood pressure drop ($\triangle P$) across the stenotic coarctation lesion. In order to evaluate the physiological significance of the pre-operative coarctation and to assess the post-operative results, the hemodynamic analysis is routinely performed by measuring the blood pressure drop ($\triangle P$) across the coarctation site via invasive cardiac catheterization.\\ The focus of this work is to present an alternative, non-invasive measurement of blood pressure drop $\triangle P$ through the introduction of a fast, image-based workflow for personalized computational modeling of the CoA? hemodynamics. {\bf Methods:} We propose an end-to-end system comprised of shape and computational models, their personalization setup using MR imaging, and a fast, non-invasive method based on computational fluid dynamics (CFD) to estimate the pre- and post-operative hemodynamics for coarctation patients. A virtual treatment method is investigated to assess the predictive power of our approach. {\bf Results:} Automatic thoracic aorta segmentation was applied on a population of 212 3D MR volumes, with mean symmetric point-to-mesh error of $3.00\pm1.58~mm$ and average computation time of $8~s$. Through quantitative evaluation of 6 CoA? patients, good agreement between computed blood pressure drop and catheter measurements is shown: average differences are $\myResPRE~mmHg$ (pre-), $\myResPOST~mmHg$ (post-operative), and $\myResVS~mmHg$ (virtual stenting), respectively. {\bf Conclusions:} The complete workflow is realized in a fast, mostly-automated system that is integrable in the clinical setting. To the best of our knowledge, this is the first time that three different settings (pre-operative - severity assessment, post-stenting - follow-up and virtual stenting - treatment outcome prediction) of CoA? are investigated on multiple subjects. We believe that in future -- given wider clinical validation -- our non-invasive {\it in-silico} method could replace invasive pressure catheterization for CoA?.
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