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Patient-specific LV flow simulations from transthoracic echocardiography: robustness evaluation and validation against Ultrasound Doppler and MRI

D. Larsson, J.H. Spuhler, S. Petersson, T. Nordenfur, M. Colarieti-Tosti, J. Hoffman, R. Winter, M. Larsson
IEEE Trans Med Imaging

Combination of high-performance computing and refined image acquisition has enabled the development of patient-specific modelling. Using such, pathological development or physiological phenomena can be studied in great detail within a simulated environment, potentially capturing the specifics of an investigated patient.

In this paper, a pathway for modelling of 3D blood flow in the left ventricle (LV) is presented, using 3D transthoracic echocardiography (3DTTE) as sole input image modality. The specifics of the pathway is presented, together with an evaluation of model robustness against variation in input data, and a review of pathway validity comparing simulated flow results to measured in-vivo data.

The figure shows the simulated 3D velocity field in one subject with normal and one with reduced LV-functionality. The colour coding and the velocity arrows indicate a complex flow behavior in both subjects. For the subject with reduced LV-functionality, significant deterioration and disruption of the main velocity jets at mid and apical LV-positions seem evident.

A key point in this paper lies in the ability to simulate complex 3D LV flow behaviour LV from 3DTTE alone, but also in the validation against in-vivo flow measurements. Specifically, with results showing relative errors between simulations and PC-MRI and PW Doppler of below 10% evaluated over 100 subjects, the potential of using the pathway for refined clinical studies is highlighted. In general, with patient-specific models enabling the study of isolated flow phenomena in direct relation to defined pathologies, the presented pathway may serve as a valuable tool for future clinical investigations of 3D blood flow motion.