Computational Fluid Dynamics Modeling of Liver Radioembolization: A Review

Aramburu, Jorge; Antón, Raúl; Rodríguez‐Fraile, Macarena; Sangro, Bruno; Bilbao, José Ignacio

doi:10.1007/s00270-021-02956-5

Cited by 17 publications

(10 citation statements)

References 48 publications

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“…Indeed, recent studies have shown that even highly simplified simulations of the transport of microspheres through a realistic hepatic vascular tree can result in biodistributions that correspond well with empirical data, corroborating this link between the properties of the vasculature, the resulting blood flow dynamics and microsphere deposition. [26][27][28][29][30] Although the posttreatment effects of radioembolization on tumor perfusion have been established before, 28 the potential for a direct link between pretreatment perfusion and posttreatment tumor absorbed dose, as proposed in this study, has not.…”

Section: Discussionmentioning

confidence: 81%

Intraprocedural C‐arm dual‐phase cone‐beam enhancement patterns correlate with tumor absorbed dose after radioembolization

Bastiaannet,

Lin,

Frey

et al. 2023

Medical Physics

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BackgroundRecent studies have shown a clear relationship between absorbed dose and tumor response to treatment after hepatic radioembolization. These findings help to create more personalized treatment planning and dosimetry. However, crucial to this goal is the ability to predict the dose distribution prior to treatment. The microsphere distribution is ultimately determined by (i) the hepatic vasculature and the resulting blood flow dynamics and (ii) the catheter position.PurposeTo show that pretreatment, intra‐procedural imaging of blood flow patterns, as quantified by catheter‐directed intra‐arterial contrast enhancement, correlate with posttreatment microsphere accumulation and, consequently, absorbed dose.Materials and methodsPatients who participated in a clinical trial (NCT01177007) and for whom both a pretreatment dual‐phase contrast‐enhanced cone‐beam CT (CBCT) and a posttreatment 90Y PET/CT scan were available were included in this retrospective study. Tumors and perfused volumes were manually delineated on the CBCT by an experienced radiologist. The mean, sum, and standard deviation of the voxels in each volume were recorded. The delineations were transferred to the PET‐based absorbed dose maps by coregistration of the corresponding CTs. Linear multiple regression was used to correlate pretreatment CBCT enhancement to posttreatment 90Y PET/CT‐based absorbed dose in each region. Leave‐one‐out cross‐validation and Bland–Altman analyses were performed on the predicted versus measured absorbed doses.ResultsNine patients, with a total of 23 tumors were included. All presented with hepatocellular carcinoma (HCC). Visually, all patients had a clear correspondence between CBCT enhancement and absorbed dose. The correlation between CBCT enhancement and posttherapy absorbed tumor dose based was strong (R2 = 0.91), and moderate for the non‐tumor liver tissue (R2 = 0.61). Limits of agreement were approximately ±55 Gray for tumor tissue.ConclusionThere is a linear relationship between pretreatment blood dynamics in HCC tumors and posttreatment absorbed dose, which, if shown to be generalizable, allows for pretreatment tumor absorbed dose prediction.

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Section: Discussionmentioning

confidence: 81%

Intraprocedural C‐arm dual‐phase cone‐beam enhancement patterns correlate with tumor absorbed dose after radioembolization

Bastiaannet,

Lin,

Frey

et al. 2023

Medical Physics

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“…If release maps similar to CPRGs need to be obtained, CFD simulations can be used to generate the flow pathlines after planar injection, as shown by Taebi et al (2021) . To estimate only the particle distribution, the CFD simulation would not even be needed, reducing the simulation time to 0 ( Aramburu et al, 2022 ). However, it should also be emphasized that the particles in this study are small, and that fluid-particle differences may increase for larger particles (i.e., for TACE).…”

Section: Discussionmentioning

confidence: 99%

A Hybrid Particle-Flow CFD Modeling Approach in Truncated Hepatic Arterial Trees for Liver Radioembolization: A Patient-specific Case Study

Bomberna

Vermijs

Lejoly

et al. 2022

Front. Bioeng. Biotechnol.

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Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. At its intermediate, unresectable stage, HCC is typically treated by local injection of embolizing microspheres in the hepatic arteries to selectively damage tumor tissue. Interestingly, computational fluid dynamics (CFD) has been applied increasingly to elucidate the impact of clinically variable parameters, such as injection location, on the downstream particle distribution. This study aims to reduce the computational cost of such CFD approaches by introducing a novel truncation algorithm to simplify hepatic arterial trees, and a hybrid particle-flow modeling approach which only models particles in the first few bifurcations. A patient-specific hepatic arterial geometry was pruned at three different levels, resulting in three trees: Geometry 1 (48 outlets), Geometry 2 (38 outlets), and Geometry 3 (17 outlets). In each geometry, 1 planar injection and 3 catheter injections (each with different tip locations) were performed. For the truncated geometries, it was assumed that, downstream of the truncated outlets, particles distributed themselves proportional to the blood flow. This allowed to compare the particle distribution in all 48 “outlets” for each geometry. For the planar injections, the median difference in outlet-specific particle distribution between Geometry 1 and 3 was 0.21%; while the median difference between outlet-specific flow and particle distribution in Geometry 1 was 0.40%. Comparing catheter injections, the maximum median difference in particle distribution between Geometry 1 and 3 was 0.24%, while the maximum median difference between particle and flow distribution was 0.62%. The results suggest that the hepatic arterial tree might be reliably truncated to estimate the particle distribution in the full-complexity tree. In the resulting hybrid particle-flow model, explicit particle modeling was only deemed necessary in the first few bifurcations of the arterial tree. Interestingly, using flow distribution as a surrogate for particle distribution in the entire tree was considerably less accurate than using the hybrid model, although the difference was much higher for catheter injections than for planar injections. Future work should focus on replicating and experimentally validating these results in more patient-specific geometries.

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“…Hemodynamics can be studied using computational fluid dynamics (CFD) [ 26 ], and recent developments in computers and medical imaging software have made the CFD analysis of blood flow both reliable and accessible to clinicians. CFD has been applied to analyze various vascular diseases, such as coronary artery disease [ 27 ], aortic dissection [ 19 , 28 , 29 ], liver radioembolization [ 30 ], and intracranial aneurysm [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

CFD Study of the Effect of the Angle Pattern on Iliac Vein Compression Syndrome

Chen

Fan

et al. 2023

Bioengineering

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Iliac vein compression syndrome (IVCS, or May–Thurner syndrome) occurs due to the compression of the left common iliac vein between the lumbar spine and right common iliac artery. Because most patients with compression are asymptomatic, the syndrome is difficult to diagnose based on the degree of anatomical compression. In this study, we investigated how the tilt angle of the left common iliac vein affects the flow patterns in the compressed blood vessel using three-dimensional computational fluid dynamic (CFD) simulations to determine the flow fields generated after compression sites. A patient-specific iliac venous CFD model was created to verify the boundary conditions and hemodynamic parameter set in this study. Thirty-one patient-specific CFD models with various iliac venous angles were developed using computed tomography (CT) angiograms. The angles between the right or left common iliac vein and inferior vena cava at the confluence level of the common iliac vein were defined as α1 and α2. Flow fields and vortex locations after compression were calculated and compared according to the tilt angle of the veins. Our results showed that α2 affected the incidence of flow field disturbance. At α2 angles greater than 60 degrees, the incidence rate of blood flow disturbance was 90%. In addition, when α2 and α1 + α2 angles were used as indicators, significant differences in tilt angle were found between veins with laminar, transitional, and turbulent flow (p < 0.05). Using this mathematical simulation, we concluded that the tilt angle of the left common iliac vein can be used as an auxiliary indicator to determine IVCS and its severity, and as a reference for clinical decision making.

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Computational Fluid Dynamics Modeling of Liver Radioembolization: A Review

Cited by 17 publications

References 48 publications

Intraprocedural C‐arm dual‐phase cone‐beam enhancement patterns correlate with tumor absorbed dose after radioembolization

Intraprocedural C‐arm dual‐phase cone‐beam enhancement patterns correlate with tumor absorbed dose after radioembolization

A Hybrid Particle-Flow CFD Modeling Approach in Truncated Hepatic Arterial Trees for Liver Radioembolization: A Patient-specific Case Study

CFD Study of the Effect of the Angle Pattern on Iliac Vein Compression Syndrome

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