False Lumen Flow Patterns and their Relation with Morphological and Biomechanical Characteristics of Chronic Aortic Dissections. Computational Model Compared with Magnetic Resonance Imaging Measurements.
False Lumen Flow Patterns and their Relation with Morphological and Biomechanical Characteristics of Chronic Aortic Dissections. Computational Model Compared with Magnetic Resonance Imaging Measurements.
复制标题
假管腔流量模式及其与慢性主动脉解剖的形态和生物力学特征的关系。与磁共振成像测量值相比，计算模型。
DOI：
10.1371/journal.pone.0170888
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Bijnens BH
中科院分区：
文献类型：
--
作者：
Rudenick PA;Segers P;Pineda V;Cuellar H;García-Dorado D;Evangelista A;Bijnens BH
主动脉壁硬度、撕裂大小和位置以及假腔 (FL) 产生的腹侧分支的存在是慢性主动脉夹层 (AD) 中 FL 扩大可能涉及的关键特性。我们假设通过相衬磁共振成像 (PC-MRI) 在横截面中测量的 FL 流型的时间变化可用于推断这些特征的综合信息。在 33 名患有慢性下降性 AD 的患者中，通过 PC-MRI 对膈肌水平 FL 的瞬时流量曲线进行了量化。我们使用集总参数模型来评估由壁刚度、撕裂大小/位置以及 FL 产生的腹部侧分支的存在引起的血流剖面变化。根据收缩期和舒张期的血流方向，在 31/33 名患者 (94%) 中确定了四种特征性 FL 血流模式： BA = 收缩期双相血流和主要是舒张期顺行血流 (n = 6)； BR = 收缩期双相血流和主要舒张期逆行血流 (n = 14)； MA = 收缩期单相血流和主要是舒张期顺行血流 (n = 9)； MR = 收缩期单相血流和主要是舒张期逆行血流 (n = 2)。在计算模型中，FL 内流向的时间变化高度依赖于沿着主动脉的评估位置。由于交通泪液的累积大小和空间分布的变化，以及源自 FL 的内脏侧分支的发生率，FL 血流模式（特别是在膈肌水平）显示出其特征模式。壁刚度的变化不会改变流量的时间变化，但它重要地决定了腔内压力。 FL 血流模式隐含地编码了 AD 中主动脉扩张的关键决定因素的形态学信息。成像方案中可能会考虑该数据来定义 FL 血流的预测值。
Aortic wall stiffness, tear size and location and the presence of abdominal side branches arising from the false lumen (FL) are key properties potentially involved in FL enlargement in chronic aortic dissections (ADs). We hypothesize that temporal variations on FL flow patterns, as measured in a cross-section by phase-contrast magnetic resonance imaging (PC-MRI), could be used to infer integrated information on these features. In 33 patients with chronic descending AD, instantaneous flow profiles were quantified in the FL at diaphragm level by PC-MRI. We used a lumped-parameter model to assess the changes in flow profiles induced by wall stiffness, tear size/location, and the presence of abdominal side branches arising from the FL. Four characteristic FL flow patterns were identified in 31/33 patients (94%) based on the direction of flow in systole and diastole: BA = systolic biphasic flow and primarily diastolic antegrade flow (n = 6); BR = systolic biphasic flow and primarily diastolic retrograde flow (n = 14); MA = systolic monophasic flow and primarily diastolic antegrade flow (n = 9); MR = systolic monophasic flow and primarily diastolic retrograde flow (n = 2). In the computational model, the temporal variation of flow directions within the FL was highly dependent on the position of assessment along the aorta. FL flow patterns (especially at the level of the diaphragm) showed their characteristic patterns due to variations in the cumulative size and the spatial distribution of the communicating tears, and the incidence of visceral side branches originating from the FL. Changes in wall stiffness did not change the temporal variation of the flows whereas it importantly determined intraluminal pressures. FL flow patterns implicitly codify morphological information on key determinants of aortic expansion in ADs. This data might be taken into consideration in the imaging protocol to define the predictive value of FL flows.