Cerebrovascular super-resolution 4D Flow MRI - using deep learning to non-invasively quantify velocity, flow, and relative pressure

The development of cerebrovascular disease is tightly coupled to changes in cerebrovascular hemodynamics, with altered flow and relative pressure indicative of the onset, development, and acute manifestation of pathology. Image-based monitoring of cerebrovascular hemodynamics is, however, complicated by the narrow and tortuous vasculature, where accurate output directly depends on sufficient spatial resolution. To address this, we present a method combining dedicated deep learning and state-of-the-art 4D Flow MRI to generate super-resolution full-field images with coupled quantification of relative pressure using a physics-driven image processing approach. The method is trained and validated in a patient-specific in-silico cohort, showing good accuracy in estimating velocity (relative error: 12.0 {+/-} 0.1%, mean absolute error (MAE): 0.07 {+/-} 0.06 m/s at peak velocity), flow (relative error: 6.6 {+/-} 4.7%, root mean square error (RMSE): 0.5 {+/-} 0.1 mL/s at peak flow), and with maintained recovery of relative pressure through the circle of Willis (relative error: 11.0 {+/-} 7.3%, RMSE: 0.3 {+/-} 0.2 mmHg). Furthermore, the method is applied to an in-vivo volunteer cohort, effectively generating data at <0.5mm resolution and showing potential in reducing low-resolution bias in relative pressure estimation. Our approach presents a promising method to non-invasively quantify cerebrovascular hemodynamics, applicable to dedicated clinical cohorts in the future.