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    Area of Science:

    • Biomedical Engineering
    • Medical Imaging
    • Cardiovascular Flow Dynamics

    Background:

    • Magnetic resonance imaging (MRI) offers 3D time-resolved relative pressure field estimation via 4D-flow MRI.
    • Clinical methods like catheterization and Doppler echocardiography provide limited 1D pressure drop data.
    • Previous research focused on 1D pressure drop accuracy from 4D-flow MRI, necessitating further evaluation of 3D pressure field estimates.

    Purpose of the Study:

    • To analyze and compare the accuracy of three state-of-the-art 3D relative pressure estimators: virtual Work-Energy Relative Pressure, Pressure Poisson Estimator (PPE), and Stokes Estimator (STE).
    • To assess the spatiotemporal characteristics and noise sensitivity of these estimators.
    • To validate estimators using a type B aortic dissection (TBAD) flow phantom and clinical patient data.

    Main Methods:

    • Computational analysis (in silico) to determine spatiotemporal characteristics and noise sensitivity.
    • Validation using a type B aortic dissection (TBAD) flow phantom with varied tear geometry and catheter pressure measurements.
    • Evaluation across eight patient cases to assess clinical workflow integration.

    Main Results:

    • In silico: Stokes Estimator (STE) showed lower pressure field errors than Pressure Poisson Estimator (PPE), though PPE was less sensitive to noise.
    • High velocity gradients and low spatial resolution significantly impacted 3D pressure field accuracy; low temporal resolution led to underestimation of peak pressures.
    • Flow phantom: Virtual Work-Energy method was most accurate, followed by STE and PPE. All estimators correlated well with ground truth, despite underestimating peak pressures.

    Conclusions:

    • All three relative pressure estimators demonstrated feasibility for clinical integration.
    • The virtual Work-Energy method showed superior accuracy in phantom validation.
    • Understanding limitations related to velocity gradients, spatial/temporal resolution, and noise is crucial for accurate 3D pressure field interpretation.