A framework for automated and objective modification of tubular structures: Application to the internal carotid...

Patient-specific medical image-based computational fluid dynamics has been widely used to reveal fundamental insight into mechanisms of cardiovascular disease, for instance, correlating morphology to adverse vascular remodeling. However, segmentation of medical images is laborious, error-prone, and a bottleneck in the development of large databases that are needed to capture the natural variability in morphology. Instead, idealized models, where morphological features are parameterized, have been used to investigate the correlation with flow features, but at the cost of limited understanding of the complexity of cardiovascular flows. To combine the advantages of both approaches, we developed a tool that preserves the patient-specificness inherent in medical images while allowing for parametric alteration of the morphology. In our open-source framework morphMan we convert the segmented surface to a Voronoi diagram, modify the diagram to change the morphological features of interest, and then convert back to a new surface. In this paper, we present algorithms for modifying bifurcation angles, location of branches, cross-sectional area, vessel curvature, shape of bends, and surface roughness. We show qualitative and quantitative validation of the algorithms, performing with an accuracy exceeding 97% in general, and proof-of-concept on combining the tool with computational fluid dynamics. By combining morphMan with appropriate clinical measurements, one could explore the morphological parameter space and resulting hemodynamic response using only a handful of segmented surfaces, effectively minimizing the main bottleneck in image-based computational fluid dynamics.