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Technical Brief

Flow Dynamics in the Aortic Arch and Its Effect on the Arterial Input Function in Cardiac Computed Tomography

[+] Author and Article Information
Parastou Eslami

Mechanical Engineering Department,
Johns Hopkins University,
Baltimore, MD 21218
e-mail: peslami1@mgh.harvard.edu

Jung-Hee Seo

Department of Mechanical Engineering,
Johns Hopkins University,
Baltimore, MD 21218

Albert C. Lardo

Department of Biomedical Engineering,
Johns Hopkins University,
Baltimore, MD 21218

Marcus Y. Chen

National Heart, Lung and Blood Institute (NHLBI),
National Institutes of Health,
Bethesda, MD 20892

Rajat Mittal

Department of Mechanical Engineering,
Johns Hopkins University,
Baltimore, MD 21218;
Division of Cardiology,
Department of Medicine,
Johns Hopkins University,
Baltimore, MD 21287

1Corresponding author.

2Present address: Department of Radiology, Massachusetts General Hospital, Harvard University, Boston, MA 02114.

Manuscript received June 13, 2018; final manuscript received February 8, 2019; published online July 15, 2019. Assoc. Editor: Keefe B. Manning.This work is in part a work of the U.S. Government. ASME disclaims all interest in the U.S. Government's contributions.

J Biomech Eng 141(10), 104501 (Jul 15, 2019) (8 pages) Paper No: BIO-18-1280; doi: 10.1115/1.4043076 History: Received June 13, 2018; Revised February 08, 2019

The arterial input function (AIF)—time-density curve (TDC) of contrast at the coronary ostia—plays a central role in contrast enhanced computed tomography angiography (CTA). This study employs computational modeling in a patient-specific aorta to investigate mixing and dispersion of contrast in the aortic arch (AA) and to compare the TDCs in the coronary ostium and the descending aorta. Here, we examine the validity of the use of TDC in the descending aorta as a surrogate for the AIF. Computational fluid dynamics (CFD) was used to study hemodynamics and contrast dispersion in a CTA-based patient model of the aorta. Variations in TDC between the aortic root, through the AA and at the descending aorta and the effect of flow patterns on contrast dispersion was studied via postprocessing of the results. Simulations showed complex unsteady patterns of contrast mixing and dispersion in the AA that are driven by the pulsatile flow. However, despite the relatively long intra-aortic distance between the coronary ostia and the descending aorta, the TDCs at these two locations were similar in terms of rise-time and up-slope, and the time lag between the two TDCs was 0.19 s. TDC in the descending aorta is an accurate analog of the AIF. Methods that use quantitative metrics such as rise-time and slope of the AIF to estimate coronary flowrate and myocardial ischemia can continue with the current practice of using the TDC at the descending aorta as a surrogate for the AIF.

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Figures

Grahic Jump Location
Fig. 1

(a) Time variation of flow velocity into the aorta and the valve opening area and the conformation of the valve leaflets during the cardiac cycle; (b) time variation of the valve compared with the velocity inflow profile: the opening time of the valve is defined as the time it takes to raise to the peak velocity and the closing phase is the time duration where the velocity drop beings in the inflow velocity until end systole; and (c) input contrast concentration for cardiac cycles compared with the velocity inflow profile

Grahic Jump Location
Fig. 2

(a) Immersed computational model where the gird is coarsened for visualization purposes, (b) the CFD ready model of aorta including the simple inflow tube along with the valve inserted at the aortic orifice shown at end diastole, (c) reference planes (S1–S11) used in the analysis of the simulation data, and (d) locations of ROIs used to determine the TDCs at the coronary ostium (left) and the descending aorta (right). The circles in all three planes are the true size ROI in which the contrast concentration was sampled.

Grahic Jump Location
Fig. 3

Streamlines through the aortic arch colored by velocity magnitude at three different stages during with the arrows pointing toward the valve tips (a) early systole at t = 1.06 s, (b) mid systole at t = 1.12 s, and (c) late systole at t = 1.33 s. The stages are indicated in (d), and (e) two views of the contours of time-averaged axial velocity at selected cross sections.

Grahic Jump Location
Fig. 4

(a) A representative example of the TDC at the descending aorta measured during CTA that is used as a surrogate for the contrast bolus in the coronary ostium, (b) time profile of normalized cross-sectional averaged contrast concentration at the coronary ostium and the descending aorta at high temporal resolution of Δt=0.01 s.  Sampled TDCs with lower temporal resolutions of, (c) Δt=0.5 s, and (d) Δt=1 s. The line with a triangular marker represents the inlet contrast concentration profile labeled as Cin. Note, there is no major difference in the two AIF's at ascending (dashed line) and descending (solid line) aorta.

Grahic Jump Location
Fig. 5

(a) Mean error between the two AIF curves at the coronary ostium and the descending aorta and (b) time-averaged axial velocity along the aorta; sectional mean velocity (square marker) and sectional maximum (circular) on the 11 axial slices shown in Fig. 2(b)

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