A personalized computational model of edema formation in myocarditis based on long-axis biventricular MRI images

Figures

• 

  Fig. 1. a LGE 4-chamber images showing the presence of an area of enhancement in the mid-wall portion of the lateral wall of the left ventricle (arrowheads). Heterogeneous, focal areas of LGE can also be identified in the septal wall. The localization of these areas of LGE are typical for patients with myocarditis and represent one of the main criteria for its diagnostic by MRI. b T2 parametric maps of the same patient in A, at the same 4-chamber slice position. The region-of-interest 1 in the lateral wall shows a T2 value of 44.8ms versus a T2 in the septum (ROI 2) of 34.5ms. The increased T2 identified in the lateral wall colocalizes with the LGE area seen in A and suggests the presence of edema/inflammation in comparison to an apparently normal area in the septum

• 

  Fig. 2. Simulation results of the edema formation using Eqs. (1), (4), (19) and (20) considering the model parameters presented in Tables 1, 2 and 3 with initial and boundary conditions defined in Table 4 after 5h of simulation. Panels A and B show the interactions between a pathogen infection and leukocytes considering an initial infection on edematous epicardium, while panels C and D show its consequences to interstitial fluid pressure and the displacement field

• 

  Fig. 3. Simulation results of the edema formation using Eqs. (1), (4), (19) and (20) considering the model parameters presented in Tables 1, 2 and 3 with initial and boundary conditions defined in Table 4 after 10h of simulation. Panels a and b show the interactions between a pathogen infection and leukocytes considering an initial infection on edematous epicardium, while panels c and d show its consequences to interstitial fluid pressure and the displacement field

• 

  Fig. 4. Comparison between the patient edema, identified by a medical doctor, and the results of the numerical simulation. Panel a show the T2 mapping imaging exam, Fig. 1b, segmented into a binary image. Panel b show the fluid phase distribution after 10 h of simulation and a contour line around the simulated edema

• 

  Fig. 5. a Finite element mesh generated based on Fig. 1b. This mesh represents a slice of the long axis of the left ventricle of the heart of the patient. b Distribution of triangular finite elements representing the lymph vessels (white) in the domain. The lymph vessels were uniformly and randomly placed over the domain corresponding to a total of 2.9% of the elements