后交通动脉瘤的形态学因素与动脉瘤侧向剪切力分布的相关性研究

发布时间：2018-04-05 15:38

  本文选题：未破裂动脉瘤　切入点：壁面侧向剪切力　出处：《浙江大学》2017年硕士论文

【摘要】：研究背景:脑动脉瘤(Intracranial Aneurysm)是颅内主要脑血管分支的病理性扩张,随着动脉成像技术的不断普及,未破裂其检出率逐年升高。大部分未破裂动脉瘤可以长期保持稳定而不进展,其中某些动脉瘤可能在短期内迅速增大导致破裂,造成严重的后果。[1-3]动脉瘤破裂导致蛛网膜下腔出血,具有极高的致死率和致残率,受累的人群也更为年轻,对家庭和社会造成巨大的负担。据目前的研究数据表明,动脉瘤的这种增长模式往往是间断的、随机的,而不是随着时间呈线性增长,破裂风险难以凭经验简单预测。[4-6]然而,目前处理动脉瘤的成本也较为昂贵,并且具有一定的风险。[7]因此,在临床工作中决定是否对一个未破裂动脉瘤进行处理是一个难题。近年来,随着3D影像技术的发展和计算机流体动力学(computer fluiddynamics,CFD)广泛被应用于脑血管血流动力学的研究,脑血管的各种形态学和血流动力学因素与动脉瘤的发生、发展与破裂的关系逐渐被揭示。就血流动力学因素而言,越来越多的研究和证据表明,壁面侧向剪切力(Wall Shear Stress,WSS)在动脉瘤的病理性过程中扮演者关键性的因素。研究表明,动脉瘤的发生往往在那些长期受到高WSS作用的血管区域,而动脉瘤的破裂与动脉瘤壁面上低WSS的作用密切相关。在临床工作中,神经外科医生接触到的往往是血管重建或是DSA造影获得的动脉瘤及其载瘤动脉的形态学因素。因此,本研究希望通过研究这些形态学因素与动脉瘤WSS的分布之间的相关性,从血流动力学角度分析哪些形态学因素更具危险性,为临床上对未破裂动脉瘤的临床决策提供一定的血流动力学依据。目的:通过研究这些形态学因素与动脉瘤WSS的分布之间的相关性,从血流动力学角度分析更具危险性的形态学因素,为临床上对未破裂动脉瘤的临床决策提供一定的血流动力学依据。方法:回顾性研究本院于本院行3D旋转DSA的后交通动脉瘤病人,导出其血管模型,通过Mimics、Geomagic和ANSYS软件逐步加工运算,实现动脉瘤及其载瘤动脉模型的重建和血流动力学的运算,并进一步获取后交通动脉瘤、颈内动脉及后交通动脉的各形态学参数,包括颈内动脉、后交通动脉的内径,颈内动脉与后交通动脉的转角,颈内动脉的后交通段的弯曲程度,后交通动脉瘤的颈宽、顶径、Aspect Ratio、体积、Size Ratio、表面积、规则程度和入流角;并获取动脉瘤壁面上的WSS的分布模式,即动脉瘤上平均WSS、受低WSS和正常及高WSS作用的区域面积。然后,通过SPSS进行统计学相关性分析,寻找各形态学因素与WSS分布相关的是否存在显著相关性。最后,本研究通过血流动力学的结果和相关文献,分析这些形态学因素的生理病理学效应。结果:本研究最终共2纳入了 25名于本院行3D旋转DSA的后交通动脉瘤病人,其中男性病人8个,女性病人17个;动脉瘤为破裂的11个,未破裂的14个。动脉瘤的顶径、Aspect Ratio 均与 Area(WSS ≤ 0.4Pa)、Area(WSS ≤ 0.4Pa)%正相关,而与Area(WSS ≥ 1.5Pa)%负相关;动脉瘤的大小指标Volume、总Area均与Area(WSS≤0.4Pa)正相关,而与Area(WSS≥1.5Pa)%负相关;动脉瘤的颈宽和Size Ratio与Area(WSS≥1.5Pa)正相关。通过流量分析可以发现,动脉瘤的流量与 Area(WSS ≤ 0.4Pa)、Area(WSS ≤ 0.4Pa)%正相关,而与 Area(WSS ≥ 1.5Pa)%、Area(WSS ≥ 1.5Pa)%负相关。结论:本文通过研究后交通动脉瘤及其载瘤动脉形态学因素与动脉瘤上血流动力学的分布特点,发现动脉瘤的大小、Aspect Ratio与动脉瘤上受低WSS作用的区域大小显著性相关,这些低WSS区域缺乏血流的直接冲击,提示低WSS区域血液的淤滞状态引起的生物学效应可能是导致动脉瘤破裂的原因,为临床上未破裂动脉瘤的处理提供了血流动力学的依据。
[Abstract]:Background: cerebral aneurysm (Intracranial Aneurysm) is the main pathological expansion of intracranial cerebral vascular branches, with artery imaging technology continues to spread, not broken the detection rate increased year by year. Most aneurysms can maintain long-term stability and progress, some of which may lead to rupture of the aneurysm increases rapidly in the short term, cause ruptured aneurysm of the serious consequences of the.[1-3], has a very high mortality rate and disability rate, affected individuals also have younger, causing a huge burden to the family and society. According to the data from the present study showed that the aneurysms in this growth model is often intermittent, random, but not with the time linear growth, fracture risk is difficult to empirically predict simple.[4-6] however, the treatment of the aneurysms cost is more expensive, and has a certain risk of.[7] therefore, in clinical In deciding whether to an unruptured aneurysm treatment is a difficult problem. In recent years, with the development of computer and fluid dynamics 3D imaging technology (computer Fluiddynamics CFD) is widely used in the study of cerebral vascular hemodynamics, various forms of cerebral vascular and hemodynamic factors and aneurysms and the relationship between development and rupture were gradually revealed. Hemodynamic factors, research and the increasing evidence indicates that lateral wall shear stress (Wall Shear Stress, WSS) plays a key factor in the pathological process of aneurysm. The research shows that the aneurysm occurred more often in those who have long been high the role of WSS in vascular area, and rupture and aneurysm wall aneurysms on the surface of the low WSS effect are closely related. In clinical work, the neurosurgeon is often exposed to vascular reconstruction or DSA angiography The morphological factors of aneurysms and aneurysms. Therefore, this research hope through the study of the correlation between the distribution of these morphological factors and aneurysm of the WSS, from the angle of hemodynamic analysis of morphological factors which is more dangerous, for the clinical of unruptured aneurysm clinical decision to provide hemodynamic basis. Objective: To study the correlation between the distribution of morphological factors and aneurysm WSS, morphological analysis of factors more dangerous from hemodynamics for the clinical perspective on clinical decision of unruptured aneurysms provide hemodynamic basis. Methods: a retrospective study in our hospital for 3D DSA after rotation traffic aneurysm patients, the vascular model derived by Mimics, Geomagic and ANSYS software gradually processing operations, implementation of aneurysm and its parent artery model reconstruction and blood flow The dynamics of operation, and further obtain the posterior communicating artery aneurysm, the morphological parameters of the internal carotid artery and posterior communicating artery, including internal carotid artery, posterior communicating artery diameter, angle of internal carotid artery and the traffic artery, the bending degree after traffic segment of internal carotid artery, posterior communicating artery aneurysm neck width, crown diameter. Aspect Ratio, Size Ratio, volume, surface area, regularity and inflow angle; distribution model and obtain the aneurysm wall of the aneurysm is WSS, average WSS, the area of low WSS and normal WSS and high effect. Then, statistical correlation analysis by SPSS, the morphological factors related with the distribution of WSS whether there is a significant correlation. Finally, through the study of hemodynamic results and related literature, analysis of physiology and pathology of these morphological factors effects. Results: at the end of this study, a total of 2 into 25 in the hospital 3D 鏃嬭浆DSA鐨勫悗浜ら，

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