Hemodynamic analysis of hepatic arteries for the early evaluation of hepatic fibrosis in biliary atresia

BACKGROUND AND OBJECTIVE Hepatic fibrosis is the prominent characteristic of biliary atresia (BA), may even progress continually after Kasai procedure (KP). BA, as a devastating pediatric hepatic disease, mainly leads to newborn cholestasis, even liver cirrhosis, eventually hepatic failure. Earlier diagnosis of hepatic fibrosis, which used to be detected by liver biopsy commonly, is consistent with better outcomes of KP. Due to potential risks and uncertainty of liver biopsy, it is an urge to seek a safer and more precise evaluation method as alternative. The purpose of this study is to investigate the hemodynamics of hepatic artery (HA) in hepatic fibrosis of early BA based on computational fluid dynamics (CFD) for evaluating the value of CFD for hepatic fibrosis diagnosis. METHODS 40 patients were divided into three groups, including the control group, the abnormal liver function group and the mild to moderate hepatic fibrosis group. CFD was applied to quantify primary hemodynamic parameters of HA and related arteries, including blood flow distribution ratio (FDR), pressure, wall shear stress (WSS) and energy loss (EL). Statistical analyses were also performed to compare the differences amongst these above groups. RESULTS With the progression of hepatic fibrosis, the increasing tendency of hemodynamic parameters values of HA and related arteries were observed. Values of FDR, pressure, WSS and EL of the mild to moderate group was higher than those of the control group and the abnormal liver function group. There were significant differences on FDRAA, FDRHA and EL between the control group and the mild to moderate hepatic fibrosis group (t = 0.037, 0.030 and <0.001, P < 0.05). CONCLUSION Significant variations of HA hemodynamics acquired by CFD between the control group and the mild to moderate hepatic fibrosis group demonstrated the relationship between the progression of hepatic fibrosis and the hemodynamic disorder, and suggested that CFD had the potential to assist the diagnosis of hepatic fibrosis in early BA.

[1]  K. Shioda,et al.  The Pathogenesis of Biliary Atresia: A Morphological Study of the Hepatobiliary System and the Hepatic Artery , 1993, Journal of pediatric gastroenterology and nutrition.

[2]  C. Datta,et al.  A histopathological study of liver and biliary remnants in the long-term survivors (>10 years) of cases of biliary atresia. , 2014, Indian journal of pathology & microbiology.

[3]  Justin E. Niehaus,et al.  Energy loss and coronary flow simulation following hybrid stage I palliation: a hypoplastic left heart computational fluid dynamic model. , 2013, Interactive cardiovascular and thoracic surgery.

[4]  G. Lederkremer,et al.  Non-invasive diagnosis of liver fibrosis and cirrhosis. , 2015, World journal of gastroenterology.

[5]  M. Wagner,et al.  Medial thickening of hepatic artery branches in biliary atresia. A morphometric study. , 2005, Journal of pediatric surgery.

[6]  S. Manda,et al.  Usefulness of ultrasonography and biochemical features in the diagnosis of cholestatic jaundice in infants , 2016 .

[7]  Jun Du,et al.  A numerical study of hepatic artery flow for prediction of congenital biliary atresia , 2017, Asian Control Conference.

[8]  Lambros Kaiktsis,et al.  Wall shear stress: theoretical considerations and methods of measurement. , 2007, Progress in cardiovascular diseases.

[9]  Charles A. Taylor,et al.  Patient-Specific Modeling of Blood Flow and Pressure in Human Coronary Arteries , 2010, Annals of Biomedical Engineering.

[10]  R. Green,et al.  Pediatric Cholestatic Liver Disease: Review of Bile Acid Metabolism and Discussion of Current and Emerging Therapies , 2020, Frontiers in Medicine.

[11]  Kasper S Wang,et al.  Recent advances in the pathogenesis and management of biliary atresia , 2015, Current opinion in pediatrics.

[12]  P. Hunter,et al.  Computational simulations for the hepatic arterial buffer response after liver graft transplantation from an adult to a child. , 2019, Medical engineering & physics.

[13]  D. Sahni,et al.  Anatomy of the hepatic arteries and their extrahepatic branches in the human liver: A cadaveric study. , 2019, Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft.

[14]  B. Sangro,et al.  Numerical zero‐dimensional hepatic artery hemodynamics model for balloon‐occluded transarterial chemoembolization , 2018, International journal for numerical methods in biomedical engineering.

[15]  Jarek Rossignac,et al.  Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions , 2018, Journal of Cardiovascular Translational Research.

[16]  C. Y. Ooi,et al.  Early and Peri-operative Prognostic Indicators in Infants Undergoing Hepatic Portoenterostomy for Biliary Atresia: a Review , 2017, Current Gastroenterology Reports.

[17]  C. Nylund,et al.  Incidence of Biliary Atresia and Timing of Hepatoportoenterostomy in the United States. , 2017, The Journal of pediatrics.

[18]  Vincent Mendez,et al.  Comparison of hemodynamic and structural indices of ascending thoracic aortic aneurysm as predicted by 2-way FSI, CFD rigid wall simulation and patient-specific displacement-based FEA , 2018, Comput. Biol. Medicine.

[19]  J. Xiang,et al.  High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis , 2014, American Journal of Neuroradiology.

[20]  A. Javadzadegan,et al.  Associations between local haemodynamics and carotid intraplaque haemorrhage with different stenosis severities: A preliminary study based on MRI and CFD , 2019, Journal of Clinical Neuroscience.

[21]  M. Alonso,et al.  Biliary Atresia: Pathogenesis and Treatment , 1998, Seminars in liver disease.

[22]  E L Yellin,et al.  Laminar‐Turbulent Transition Process in Pulsatile Flow , 1966, Circulation research.

[23]  F. White,et al.  Hepatic fibrosis and survival in biliary atresia. , 2004, The Journal of pediatrics.

[24]  R G Mark,et al.  Numerical analysis of blood flow through a stenosed artery using a coupled multiscale simulation method , 2000, Computers in Cardiology 2000. Vol.27 (Cat. 00CH37163).

[25]  S. Ieiri,et al.  Morphometric demonstration of portal vein stenosis and hepatic arterial medial hypertrophy in patients with biliary atresia , 2019, Pediatric Surgery International.

[26]  C. Yoon,et al.  Biliary atresia: color doppler US findings in neonates and infants. , 2009, Radiology.

[27]  Siamak N. Doost,et al.  Heart blood flow simulation: a perspective review , 2016, Biomedical engineering online.

[28]  Byoung-Kwon Lee,et al.  Computational Fluid Dynamics in Cardiovascular Disease , 2011, Korean circulation journal.

[29]  R. Schreiber.  Newborn Screening for Biliary Atresia. , 2020, JAMA.

[30]  Ioan Sporea,et al.  Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. , 2018, Ultrasound in medicine & biology.

[31]  R. Superina,et al.  The evolution of early liver biopsy findings in babies with jaundice may delay the diagnosis and treatment of biliary atresia. , 2020, Journal of pediatric surgery.

[32]  Amal Ahmed Owida,et al.  Numerical analysis of coronary artery bypass grafts: An over view , 2012, Comput. Methods Programs Biomed..

[33]  K Rohr,et al.  Personalized stent design for congenital heart defects using pulsatile blood flow simulations. , 2018, Journal of biomechanics.

[34]  G. Ferraioli,et al.  Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement. , 2020, Radiology.

[35]  Sudharsan Madhavan,et al.  The effect of inlet and outlet boundary conditions in image-based CFD modeling of aortic flow , 2018, BioMedical Engineering OnLine.

[36]  Wen-chun Li,et al.  Morphological and biomechanical remodelling of the hepatic artery in a swine model of portal hypertension , 2012, Hepatology International.

[37]  J. Fujimoto,et al.  Regional Hepatic Regeneration After Liver Resection Correlates Well with Preceding Changes in the Regional Portal Circulation in Humans , 2013, Digestive Diseases and Sciences.

[38]  W. Poon,et al.  Current status of computational fluid dynamics for cerebral aneurysms: The clinician’s perspective , 2011, Journal of Clinical Neuroscience.

[39]  Xuelan Zhang,et al.  Analysis of the formation mechanism and occurrence possibility of Post-Stenotic Dilatation of the aorta by CFD approach , 2020, Comput. Methods Programs Biomed..

[40]  K. Govindarajan.  Biliary atresia: Where do we stand now? , 2016, World journal of hepatology.

[41]  M. Umezu,et al.  Computational Hemodynamic Analysis in Congenital Heart Disease: Simulation of the Norwood Procedure , 2010, Annals of Biomedical Engineering.

[42]  Charles A. Taylor,et al.  On Coupling a Lumped Parameter Heart Model and a Three-Dimensional Finite Element Aorta Model , 2009, Annals of Biomedical Engineering.