It has been demonstrated that computational fluid dynamics (CFD) have the potential to enhance the comprehension of the role played by hemodynamic factors involved in atherosclerosis. Recently, phase-contrast magnetic resonance imaging (PC-MRI) has emerged as an effective tool for providing accurate vascular geometries for CFD simulations and quantitative data on blood flow rates, which can be used to specify realistic boundary conditions (BCs). However, the application of acquired flow waveforms at boundaries is not straightforward, mainly (i) due to possible occurrences of phase shifts and attenuations of outflow with respect to inflow rate and (ii) due to the instantaneous mass conservation constraint, which is required in hemodynamic simulations with rigid wall models, but is not guaranteed in in vivo measurements. As an alternative, new boundary conditions schemes have been developed in an effort to consider the interaction between the computational domain and the upstream/downstream vasculature by coupling through-scale hemodynamic models [1]. However, the identification of the parameters of these simplified vascular models on a subject-specific base involves both pressure and flow rates measurements [2]. In this context, it is clear that the direct application of individual PC-MRI measured flow rates waveforms as BCs in patient-specific simulations should be preferred [3]. In order to overcome the limitations mentioned above, measured flow rates should be combined with stress-free conditions or fixed mass flow ratio (derived from the same set of PC-MRI data) between inlet and multiple outlet sections. However, prescribing different BCs at boundaries can affect the solutions of the equations governing blood flow [1]. For this reason, different strategies in combining outlet BCs could lead to different simulated hemodynamics. This work analyzes the influence of different possible strategies of applying PC-MRI measured flow rates on an image-based hemodynamic model of a healthy human aortic arch with supra-aortic vessels. A total of six flow simulations was carried out applying six different schemes for treating BCs at outlets. Three common wall shear stress (WSS)-based indicators of abnormal flow were considered and the sensitivity of these indicators to the outlet treatment strategy was evaluated.

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