Hemodynamics of Cerebral Aneurysms: Connecting Medical Imaging and Biomechanical Analysis

Annu Rev Biomed Eng. 2020 Jun 4:22:231-256. doi: 10.1146/annurev-bioeng-092419-061429. Epub 2020 Mar 25.

Abstract

In the last two decades, numerous studies have conducted patient-specific computations of blood flow dynamics in cerebral aneurysms and reported correlations between various hemodynamic metrics and aneurysmal disease progression or treatment outcomes. Nevertheless, intra-aneurysmal flow analysis has not been adopted in current clinical practice, and hemodynamic factors usually are not considered in clinical decision making. This review presents the state of the art in cerebral aneurysm imaging and image-based modeling, discussing the advantages and limitations of each approach and focusing on the translational value of hemodynamic analysis. Combining imaging and modeling data obtained from different flow modalities can improve the accuracy and fidelity of resulting velocity fields and flow-derived factors that are thought to affect aneurysmal disease progression. It is expected that predictive models utilizing hemodynamic factors in combination with patient medical history and morphological data will outperform current risk scores and treatment guidelines. Possible future directions include novel approaches enabling data assimilation and multimodality analysis of cerebral aneurysm hemodynamics.

Keywords: cerebral hemodynamics; computational fluid dynamics; data fusion; image-based modeling; modeling uncertainty; patient-specific numerical simulations; translational research.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Aneurysm / diagnostic imaging
  • Animals
  • Arteries / diagnostic imaging
  • Biomechanical Phenomena*
  • Blood Flow Velocity / physiology
  • Computer Simulation
  • Decision Making
  • Diagnostic Imaging / methods*
  • Disease Progression
  • Hemodynamics
  • Humans
  • Image Processing, Computer-Assisted
  • Imaging, Three-Dimensional
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / therapy
  • Models, Cardiovascular
  • Postoperative Period
  • Risk
  • Tomography, X-Ray Computed
  • Translational Research, Biomedical