Hemodynamic Differences in Intracranial Aneurysms before and after Rupture
Hemodynamic Differences in Intracranial Aneurysms before and after Rupture
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DOI：
10.3174/ajnr.a4385
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发表时间：
2015-10-01
影响因子：
3.5
通讯作者：
Marquering, H. A.
中科院分区：
文献类型：
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作者：
Cornelissen, B. M. W.;Schneiders, J. J.;Marquering, H. A.
背景和目的：颅内动脉瘤的破裂风险可能取决于血流动力学特征。这是通过比较破裂和未破裂动脉瘤的血流动力学数据来评估的。然而，动脉瘤的几何形状可能在破裂之前、期间或之后发生变化；这种差异会导致血流动力学的潜在变化。我们通过使用破裂前后的 3D 成像来评估一系列颅内动脉瘤的血流动力学变化。 材料和方法：对于 9 名患者的 9 个动脉瘤，我们在破裂前后使用 MRA、CTA 和 3D 旋转血管造影来生成动脉瘤和瘤周血管系统的几何模型。使用计算流体动力学模拟动脉瘤内血流动力学。两名神经放射科医生通过使用流速流线和壁剪切应力分布，一致地定性评估了血流复杂性、血流稳定性、流入浓度和血流冲击。结果：9 个动脉瘤中有 6 个的血流动力学发生了变化。这 6 例破裂前后影像学检查之间的中位时间为 678 天（范围为 14-1461 天），而 3 例血流动力学未改变的病例为 151 天（范围为 34-183 天）。观察到流动复杂性 (n = 3)、流动稳定性 (n = 3)、流入浓度 (n = 2) 和流动冲击区域 (n = 3) 的变化。在所有情况下，这些变化都与由于破裂相关血肿、生长或新形成的分叶而导致的动脉瘤移位有关。结论：颅内动脉瘤的血流动力学特征可以通过破裂之前、期间或之后的几何变化而改变。因此，应谨慎解释从比较破裂动脉瘤和未破裂动脉瘤的病例对照研究中获得的血流动力学特征与动脉瘤破裂之间的关联。
BACKGROUND AND PURPOSE: Rupture risk of intracranial aneurysms may depend on hemodynamic characteristics. This has been assessed by comparing hemodynamic data of ruptured and unruptured aneurysms. However, aneurysm geometry may change before, during, or just after rupture; this difference causes potential changes in hemodynamics. We assessed changes in hemodynamics in a series of intracranial aneurysms, by using 3D imaging before and after rupture.MATERIALS AND METHODS: For 9 aneurysms in 9 patients, we used MRA, CTA, and 3D rotational angiography before and after rupture to generate geometric models of the aneurysm and perianeurysmal vasculature. Intra-aneurysmal hemodynamics were simulated by using computational fluid dynamics. Two neuroradiologists qualitatively assessed flow complexity, flow stability, inflow concentration, and flow impingement in consensus, by using flow-velocity streamlines and wall shear stress distributions.RESULTS: Hemodynamics changed in 6 of the 9 aneurysms. The median time between imaging before and after rupture was 678 days (range, 14-1461 days) in these 6 cases, compared with 151 days (range, 34-183 days) in the 3 cases with unaltered hemodynamics. Changes were observed for flow complexity (n = 3), flow stability (n = 3), inflow concentration (n = 2), and region of flow impingement (n = 3). These changes were in all instances associated with aneurysm displacement due to rupture-related hematomas, growth, or newly formed lobulations.CONCLUSIONS: Hemodynamic characteristics of intracranial aneurysms can be altered by geometric changes before, during, or just after rupture. Associations of hemodynamic characteristics with aneurysm rupture obtained from case-control studies comparing ruptured with unruptured aneurysms should therefore be interpreted with caution.