We present the framework GUCCI (Guided Cardiac Cohort Investigation), which provides a guided visual analytics workflow to analyze cohort-based measured blood flow data in the aorta. In the past, many specialized techniques have been developed for the visual exploration of such data sets for a better understanding of the influence of morphological and hemodynamic conditions on cardiovascular diseases. However, there is a lack of dedicated techniques that allow visual comparison of multiple data sets and defined cohorts, which is essential to characterize pathologies. GUCCI offers visual analytics techniques and novel visualization methods to guide the user through the comparison of predefined cohorts, such as healthy volunteers and patients with a pathologically altered aorta. The combination of overview and glyph-based depictions together with statistical cohort-specific information allows investigating differences and similarities of the time-dependent data. Our framework was evaluated in a qualitative user study with three radiologists specialized in cardiac imaging and two experts in medical blood flow visualization. They were able to discover cohort-specific characteristics, which supports the derivation of standard values as well as the assessment of pathology-related severity and the need for treatment.

An accurate assessment of the cardiovascular system and prediction of cardiovascular diseases (CVDs) are crucial. Cardiac blood flow data provide insights about patient-specific hemodynamics. However, there is a lack of machine learning approaches for a feature-based classification of heart-healthy people and patients with CVDs. In this paper, we investigate the potential of morphological and hemodynamic features extracted from measured blood flow data in the aorta to classify heart-healthy volunteers (HHV) and patients with bicuspid aortic valve (BAV). Furthermore, we determine features that distinguish male vs. female patients and elderly HHV vs. BAV patients. We propose a data analysis pipeline for cardiac status classification, encompassing feature selection, model training, and hyperparameter tuning. Our results suggest substantial differences in flow features of the aorta between HHV and BAV patients. The excellent performance of the classifiers separating between elderly HHV and BAV patients indicates that aging is not associated with pathological morphology and hemodynamics. Our models represent a first step towards automated diagnosis of CVS using interpretable machine learning models.

Abstract Flow in the great arteries (aorta, pulmonary artery) is normally laminar with a parabolic velocity profile. Eccentric flow jets are linked to various diseases like aneurysms. Cardiac 4D PC‐MRI data provide spatio‐temporally resolved blood flow information for the whole cardiac cycle. In this work, we establish a time‐dependent visualization and quantification of flow jets. For this purpose, equidistant measuring planes are automatically placed along the vessel's centerline. The flow jet position and region with highest velocities are extracted for every plane in each time step. This is done during pre‐processing and without user‐defined parameters. We visualize the main flow jet as geometric tube. High‐velocity areas are depicted as a net around this tube. Both geometries are time‐dependent and can be animated. Quantitative values are provided during cross‐sectional measuring plane‐based evaluation. Moreover, we offer a plot visualization as summary of flow jet characteristics for the selected plane. Our physiologically plausible results are in accordance with medical findings. Our clinical collaborators appreciate the possibility to view the flow jet in the whole vessel at once, which normally requires repeated pathline filtering due to varying velocities along the vessel course. The overview plots are considered as valuable for documentation purposes.

Abstract Four‐dimensional phase‐contrast magnetic resonance imaging (4D PC‐MRI) allows the non‐invasive acquisition of time‐resolved, 3D blood flow information. Stroke volumes (SVs) and regurgitation fractions (RFs) are two of the main measures to assess the cardiac function and severity of valvular pathologies. The flow rates in forward and backward direction through a plane above the aortic or pulmonary valve are required for their quantification. Unfortunately, the calculations are highly sensitive towards the plane's angulation since orthogonally passing flow is considered. This often leads to physiologically implausible results. In this work, a robust quantification method is introduced to overcome this problem. Collaborating radiologists and cardiologists were carefully observed while estimating SVs and RFs in various healthy volunteer and patient 4D PC‐MRI data sets with conventional quantification methods, that is, using a single plane above the valve that is freely movable along the centerline. By default it is aligned perpendicular to the vessel's centerline, but free angulation (rotation) is possible. This facilitated the automation of their approach which, in turn, allows to derive statistical information about the plane angulation sensitivity. Moreover, the experts expect a continuous decrease of the blood flow volume along the vessel course. Conventional methods are often unable to produce this behaviour. Thus, we present a procedure to fit a monotonous function that ensures such physiologically plausible results. In addition, this technique was adapted for the usage in branching vessels such as the pulmonary artery. The performed informal evaluation shows the capability of our method to support diagnosis; a parameter evaluation confirms the robustness. Vortex flow was identified as one of the main causes for quantification uncertainties.

In the last years, illustrative methods have found their way into flow visualization since they communicate difficult information in a comprehensible way. This is of great benefit especially in domains where the audience does not necessarily have flow expertise. One such domain is the medical field where the development of 4D MR imaging (for in-vivo 3D blood flow measurement) lead to an increased demand for easy flow analysis techniques. The goal and the challenge is to transfer the data into simple visualizations supporting the physician with flow interpretation and decision making. In this work, we take one step towards this goal. We present an approach for the illustrative visualization of steady flow features occurring in 4D MRI data of heart and aorta. Like shown in manually created illustrations, we restrict our visualization to the main data characteristics and do not depict every flow detail. The input for our method are flow features extracted from a dataset's complete set of streamlines with the help of line predicates. We create an abstract depiction of these line bundles by selecting a set of bundle representatives reflecting the most important flow aspects. These lines are rendered as three-dimensional arrows that are fused in areas where they represent the same flow. Since vortices are another important flow information for a physician, we identify these regions in the 4D MRI data and display them as unobtrusive, tube-like structures. A hatching texture provides for a visual effect of rotational blood flow. By applying our illustration technique to diverse flow structures of several 4D MRI datasets, we demonstrate that the abstract visualization is useful to gain an easier insight into the data. Feedback of medical experts confirmed the usefulness and revealed limitations of our work. The images are restricted to the essential flow features and, therefore, clearer and less cluttered. Our method has great potential and offers many possible applications, e.g., in comparative visualization and also beyond the medical domain.

Four-dimensional MRI is an in vivo flow imaging modality that is expected to significantly enhance the understanding of cardiovascular diseases. Among other fields, 4D MRI provides valuable data for the research of cardiac blood flow and with that the development, diagnosis, and treatment of various cardiac pathologies. However, to gain insights from larger research studies or to apply 4D MRI in the clinical routine later on, analysis techniques become necessary that allow to robustly identify important flow characteristics without demanding too much time and expert knowledge. Heart muscle contractions and the particular complexity of the flow in the heart imply further challenges when analyzing cardiac blood flow. Working toward the goal of simplifying the analysis of 4D MRI heart data, we present a visual analysis method using line predicates. With line predicates precalculated integral lines are sorted into bundles with similar flow properties, such as velocity, vorticity, or flow paths. The user can combine the line predicates flexibly and by that carve out interesting flow features helping to gain overview. We applied our analysis technique to 4D MRI data of healthy and pathological hearts and present several flow aspects that could not be shown with current methods. Three 4D MRI experts gave feedback and confirmed the additional benefit of our method for their understanding of cardiac blood flow.

Cardiovascular diseases (CVD) are the leading cause of death worldwide. Their initiation and evolution depends strongly on the blood flow characteristics. In recent years, advances in 4D PC-MRI acquisition enable reliable and time-resolved 3D flow measuring, which allows a qualitative and quantitative analysis of the patient-specific hemodynamics. Currently, medical researchers investigate the relation between characteristic flow patterns like vortices and different pathologies. The manual extraction and evaluation is tedious and requires expert knowledge. Standardized, (semi-)automatic and reliable techniques are necessary to make the analysis of 4D PC-MRI applicable for the clinical routine. In this work, we present an approach for the extraction of vortex flow in the aorta and pulmonary artery incorporating line predicates. We provide an extensive comparison of existent vortex extraction methods to determine the most suitable vortex criterion for cardiac blood flow and apply our approach to ten datasets with different pathologies like coarctations, Tetralogy of Fallot and aneurysms. For two cases we provide a detailed discussion how our results are capable to complement existent diagnosis information. To ensure real-time feedback for the domain experts we implement our method completely on the GPU.