Transcript Computer Modeling and Simulation for Neuro Vascular

NOVA
Non-invasive Optimal Vessel Analysis
Qmra™
MRA + NOVA
Quantitative
Magnetic Resonance Angiography
President and Chief Scientific Officer
VasSol was founded in 1999 by Dr.
Fady T. Charbel, Professor and Head
of the Department of Neurosurgery
at the University of Illinois at
Chicago.
Dr. Charbel’s groundbreaking work
on the cerebrovascular flow
modeling led to VasSol, the first
commercial company to emerge
from the College of Medicine at UIC.
Among his many accomplishments
Dr. Charbel is the inventor of the
Charbel Micro-Flowprobe and has
developed many surgical techniques,
including C-FAST (Charbel flow
assisted surgical technique).
Dr. Fady T. Charbel, MD, FACS
CANVAS (Computer Aided Neuro Vascular Analysis and Simulation) Group
Imaging
Treatment Planning
Diagnostic
Thin Internet Server
MRI
PCMR
OR Surgical Planning
Radiology
Angio
AIM
FEM
Rapid Prototype
CT
Image Registration
Multimedia Notebook
Phase-contrast MR (PCMR)
 Phase shift proportional to velocity 相移與速度
成正比
 Cross sectional area from vessel contour 血
管的橫斷面面積
 Flow = Velocity x Area 流量=速度x面積
NOVA technique for QMRA
– Axial 3-D TOF MRA with 3-D surface rendering of
cerebral vasculature 腦部血管系統的3D模型
NOVA technique for QMRA
– Cuts placed perpendicular to axis of vessel 量測切面垂直於血管軸向
NOVA technique for QMRA
– Gated 2D phase contrast MR scan perpendicular to the
vessel axis 閘控2D PCMR 掃描垂直於血管軸向
PCMR is a highly accurate
method, however it requires:
 Perpendicular measurement plane 垂直的量
測面
 Laminar flow 層流
 Appropriate Venc setting 適當的VENC設定
The NOVA Solution
NOVA 3D
Quick, accurate
vessel identification
快速、準確、血管辨認
Optimal,
perpendicular cut
垂直切面
Auto Venc
detects Venc
mismatch and
determines correct
setting 偵測Venc錯配並決
定正確設定
NOVA is Easy to Use
 NOVA 3D Localizer Nova 3D定位器
 Auto prescription 自動標註血管名稱
 Auto Transfer of 3D Coordinates 自動轉換3D
座標
 Auto Contouring of Vessel Border 自動標示血
管邊界
 VENC Check – Takes away the
guesswork VENC檢查 ─ 省去猜測的工作
Nova Results
Phase contrast MRA
Qmra™ Protocol for Head and Neck
NOVA Validation
 In Vitro multi- tube phantom
 In Vivo
animal model
 Steady flow
different flow rates
 Pulsatile flow different flow rates
 Different vendors GE, Philips
and SIEMENS
 Gated/non-gated sequences
Gated/non-gated sequences
•In Vivo Validation of Quantitative Magnetic Resonance Angiography in
Canine Carotid Artery Model
Mateo Calderon – Arnulphi MD
Normative Flow Ranges
Baseline Cerebral Blood Flow Study (UIC):
(Amin-Hanjani et al, International Stroke Conference, 2011)




326 healthy subjects 326位健康受測者
Age range 18-84 (mean 47) 年齡範圍18-84歲 (平均47歲)
48% female/ 52% male 48%女性 / 52%男性
Three age groups 三個年齡群組: 18-40
41-60
>60
NOVA Applications
 Cerebrovascular disease and disorders 腦血管疾病及失調:
Extracranial and intracranial arterial stenosis and occlusion
Moyamoya Disease
Arterial dissection
Cerebral Aneurysm
Venous stenosis
Arteriovenous Malformation
 Monitor pre/post treatment 監控術前/術後治療:
Angioplasty and stenting
EC-IC bypass – flow augmentation for ischemia and flow replacement (aneurysm, tumor)
Carotid revascularization
Embolization and surgical resection of AVMs
Flow diversion for cerebral aneurysm
Evaluate effectiveness of medical therapy, and select patients for intervention
Role of Quantitative Flow Assessment:
• Patient selection/ decision-making 患者選擇/決策決定
• Long-term monitoring/ post-treatment follow-up
長時間監控/ 後續治療追蹤
Accumulation of knowledge
Basilar Artery Stent
Serial Follow up post basilar artery stenting
April 3
April 12
April 21
April 25
MCA Aneurysm 10M post stent assisted coiling instent stenosis within the right M1 segment measuring
50 - 70%.
RMCA flow in normal range
NOVA 2/2012 vessel map, 3D
NOVA QMRA
Evaluate individual vessels: Right
AVM
MCA:
953 cc/min  184 cc/min
Primary Draining Vein:
768 ml/min  68 cc/min
NOVA Flow Rate (ml/min) of Feeding Artery
and Draining Vein During the Treatment process
Right Frontal AVM with Treatments of Embolizations and Resection
Draining Vein
RICA
RMCA
RJV
1242
1191
953
760
1008
958
737
627
509
777
716
562
277
500
343
506
768
604
301
605
378
496
431
447
371
184
316
68
Baseline
1st Embo
2nd Embo
3rd Embo
4th Embo
5th Embo
Resection
PREOP Right ICA Occlusion
Right middle cerebral artery flow measurements, pre (left) and post (right) diamox.
NOVA Vessel Map
Pre diamox
Post diamox
% change
RACA and RPCA flows
decrease after diamox
RMCA increases only
marginally, 6%
POST OP
ANGIO AND
NOVA
VERiTAS study
Vertebral flow Evaluation and Risk of Transient Ischemic Attack
and Stroke
(VERiTAS) study VERiTAS研究─短暫缺血性中風在脊椎的流量風險評估
Prospective multicenter observational study
of patients with symptomatic
vertebrobasilar disease using QMRA:
Does flow compromise stratify stroke risk?
NOVA (QMRA) for Symptomatic VBD
Normal Flow
Basilar stenosis
Low Flow
Basilar occlusion
MyRIAD Study - Mechanisms of
early Recurrence
of Intracranial Atherosclerotic Disease
MyRIAD研究─臚內血管硬化的早期復發機制研究
Start Date: July 2014
175 patients
3 imaging modalities to elucidate the mechanisms of recurrent stroke:
NOVA QMRA
MR Perfusion
Transcranial Doppler
http://clinicaltrials.gov/show/NCT02121028
Validation of a Robust PCMR Method for
Quantifying CSF Flow in Human Subjects
Kezhou Wang, Xinjian Du, Wei Sun, Hagai Ganin, Yi Sui, Lauren Ostergren, Fady T. Charbel,
William G. Bradley, Xiaohong Joe Zhou
Department of Neurosurgery, University of Illinois at Chicago Medical Center; VasSol,
Inc.;
GE Healthcare; Department of Radiology, University of California at San Diego
FIESTA image showing the CSF. (b) 3D model of aqueduct with flow measurement
location shown in yellow. (c) 2D PCMR phase image perpendicular to aqueduct.
a
b
)
)
Quantitative Flow Assessment
Intracranial atherosclerotic occlusive disease
顱內血管硬化阻塞疾病:
 Current focus on ‘anatomy’ of the disease
目前專注在疾病的解剖
 Consider the ‘physiology’ of the disease
思考疾病的生理
FLOW MATTERS 血流非常重要
Thank you!