Abstract Simulations and measurements of blood and airflow inside the human circulatory and respiratory system play an increasingly important role in personalized medicine for prevention, diagnosis and treatment of diseases. This survey focuses on three main application areas. (1) Computational fluid dynamics (CFD) simulations of blood flow in cerebral aneurysms assist in predicting the outcome of this pathologic process and of therapeutic interventions. (2) CFD simulations of nasal airflow allow for investigating the effects of obstructions and deformities and provide therapy decision support. (3) 4D phase‐contrast (4D PC) magnetic resonance imaging of aortic haemodynamics supports the diagnosis of various vascular and valve pathologies as well as their treatment. An investigation of the complex and often dynamic simulation and measurement data requires the coupling of sophisticated visualization, interaction and data analysis techniques. In this paper, we survey the large body of work that has been conducted within this realm. We extend previous surveys by incorporating nasal airflow, addressing the joint investigation of blood flow and vessel wall properties and providing a more fine‐granular taxonomy of the existing techniques. From the survey, we extract major research trends and identify open problems and future challenges. The survey is intended for researchers interested in medical flow but also more general, in the combined visualization of physiology and anatomy, the extraction of features from flow field data and feature‐based visualization, the visual comparison of different simulation results and the interactive visual analysis of the flow field and derived characteristics.

Computational fluid dynamic (CFD) simulations of blood flow provide new insights into the hemodynamics of vascular pathologies such as cerebral aneurysms. Understanding the relations between hemodynamics and aneurysm initiation, progression, and risk of rupture is crucial in diagnosis and treatment. Recent studies link the existence of vortices in the blood flow pattern to aneurysm rupture and report observations of embedded vortices -a larger vortex encloses a smaller one flowing in the opposite direction -whose implications are unclear. We present a clustering-based approach for the visual analysis of vortical flow in simulated cerebral aneurysm hemodynamics. We show how embedded vortices develop at saddle-node bifurcations on vortex core lines and convey the participating flow at full manifestation of the vortex by a fast and smart grouping of streamlines and the visualization of group representatives. The grouping result may be refined based on spectral clustering generating a more detailed visualization of the flow pattern, especially further off the core lines. We aim at supporting CFD engineers researching the biological implications of embedded vortices.

Understanding the hemodynamics of blood flow in vascular pathologies such as intracranial aneurysms is essential for both their diagnosis and treatment. Computational fluid dynamics (CFD) simulations of blood flow based on patient-individual data are performed to better understand aneurysm initiation and progression and more recently, for predicting treatment success. In virtual stenting, a flow-diverting mesh tube (stent) is modeled inside the reconstructed vasculature and integrated in the simulation. We focus on steady-state simulation and the resulting complex multiparameter data. The blood flow pattern captured therein is assumed to be related to the success of stenting. It is often visualized by a dense and cluttered set of streamlines.We present a fully automatic approach for reducing visual clutter and exposing characteristic flow structures by clustering streamlines and computing cluster representatives. While individual clustering techniques have been applied before to streamlines in 3D flow fields, we contribute a general quantitative and a domain-specific qualitative evaluation of three state-of-the-art techniques. We show that clustering based on streamline geometry as well as on domain-specific streamline attributes contributes to comparing and evaluating different virtual stenting strategies. With our work, we aim at supporting CFD engineers and interventional neuroradiologists.

Abstract The qualitative exploration of near‐wall hemodynamics in cerebral aneurysms provides important insights for risk assessment. For instance, a direct relation between complex flow patterns and aneurysm formation could be observed. Due to the high complexity of the underlying time‐dependent flow data, the exploration is challenging, in particular for medical researchers not familiar with such data. We present the AmniVis‐Explorer, a system that is designed for the preparation of a qualitative medical study. The provided features were developed in close collaboration with medical researchers involved in the study. This comprises methods for a purposeful selection of surface regions of interest and a novel approach to provide a 2D overview of flow patterns that are represented by streamlines at these regions. Furthermore, we present a specialized interface that supports binary classification of patterns and temporal exploration as well as methods for selection, highlighting and automatic 3D navigation to particular patterns. Based on eight representative datasets, we conducted informal interviews with two bord‐certified radiologists and a flow expert to evaluate the system. It was confirmed that the AmniVis‐Explorer allows for an easy selection, qualitative exploration and classification of near‐wall flow patterns that are represented by streamlines.

Cerebral aneurysms are a pathological vessel dilatation that bear a high risk of rupture. For the understanding and evaluation of the risk of rupture, the analysis of hemodynamic information plays an important role. Besides quantitative hemodynamic information, also qualitative flow characteristics, e.g., the inflow jet and impingement zone are correlated with the risk of rupture. However, the assessment of these two characteristics is currently based on an interactive visual investigation of the flow field, obtained by computational fluid dynamics (CFD) or blood flow measurements. We present an automatic and robust detection as well as an expressive visualization of these characteristics. The detection can be used to support a comparison, e.g., of simulation results reflecting different treatment options. Our approach utilizes local streamline properties to formalize the inflow jet and impingement zone. We extract a characteristic seeding curve on the ostium, on which an inflow jet boundary contour is constructed. Based on this boundary contour we identify the impingement zone. Furthermore, we present several visualization techniques to depict both characteristics expressively. Thereby, we consider accuracy and robustness of the extracted characteristics, minimal visual clutter and occlusions. An evaluation with six domain experts confirms that our approach detects both hemodynamic characteristics reasonably.

Abstract For cerebral aneurysms, the ostium, the area of inflow, is an important anatomic landmark, since it separates the pathological vessel deformation from the healthy parent vessel. A better understanding of the inflow characteristics, the flow inside the aneurysm and the overall change of pre‐ and post‐aneurysm flow in the parent vessel provide insights for medical research and the development of new risk‐reduced treatment options. We present an approach for a qualitative, visual flow exploration that incorporates the ostium and derived anatomical landmarks. It is divided into three scopes: a global scope for exploration of the in‐ and outflow, an ostium scope that provides characteristics of the flow profile close to the ostium and a local scope for a detailed exploration of the flow in the parent vessel and the aneurysm. The approach was applied to five representative datasets, including measured and simulated blood flow. Informal interviews with two board‐certified radiologists confirmed the usefulness of the provided exploration tools and delivered input for the integration of the ostium‐based flow analysis into the overall exploration workflow.