破裂前期后交通动脉动脉瘤的形态学及血流动力学分析

摘要

Objective To identify the significant morphologic and hemodynamic parameters in per -ruptured period and assess the risk factors of intracranial aneurysms.Methods The CFD model was constructed from patient-specific 3D rotation angiographic images.Three-cardiac-cycle simulation was performed and the morphologic and hemodynamic parameters in the second cardiac cycle were calculated and analyzed in the pre-ruptured and ruptured group.Results There was no significant statistical difference between two groups in the morphologic parameters.The Hemodynamic parameter significantly different between the two groups was the WSS of aneurysm wall (P =0.024).For pre-ruptured group,there was a statistically significant correlation between AR and LSA (rs =0.833,P =0.005),AR and OSI (rs =0.817,P =0.007),SR and WSS of aneurysm wall (rs =-0.683,P =0.042) ; for ruptured group,there was no significant correlation established.Conclusions The "pre-ruptured" aneurysms had similar morphologic and hemodynamic characteristics compared with the ruptured ones.Low WSS and bleb formation might play an important role in aneurysm rupture.%目的 明确破裂前期颅内动脉瘤的形态学及血流动力学特征,评估颅内动脉瘤的破裂风险因素.方法 构建特异性破裂前期动脉瘤计算流体力学模型,并将其与破裂组后交通动脉动脉瘤进行了形态和血流动力学的数值模拟结果进行比较研究.结果 破裂前期组与破裂组在形态学指标及瘤体低壁面切应力面积比(LSA)、瘤体剪切震荡指数(OSI)等血流动力学指标上差异无统计学意义,而破裂前期组平均瘤体壁面切应力(WSS)较破裂组显著降低(P=0.024);其中颈体比(AR)与LSA和OSI存在正相关关系,体径比(SR)与平均瘤体WSS存在负相关关系.结论 处于破裂前期的颅内动脉瘤与破裂颅内动脉瘤有着相似形态学及血流动力学特征,较低的WSS和子囊的形成可能是促进动脉瘤破裂的重要因素.