Identification of Hostile Hemodynamics and Geometries of Cerebral Aneurysms: A Case-Control Study.
Identification of Hostile Hemodynamics and Geometries of Cerebral Aneurysms: A Case-Control Study.
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DOI：
10.3174/ajnr.a5764
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发表时间：
2018-10
期刊：
影响因子：
--
通讯作者：
Cebral JR
中科院分区：
文献类型：
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作者：
Chung BJ;Mut F;Putman CM;Hamzei-Sichani F;Brinjikji W;Kallmes D;Jimenez CM;Cebral JR
为了确定与动脉瘤不稳定和破裂相关的不良血流动力学条件和几何形状，本研究在控制位置和患者特征的同时，比较了稳定、不稳定和破裂的动脉瘤。比较165个稳定动脉瘤、65个不稳定动脉瘤和554个破裂动脉瘤的血流动力学和几何形状。血流动力学采用基于图像的计算流体动力学建模。选取符合动脉瘤位置、患者年龄和性别的病例对照。配对Wilcoxon检验用于比较不同动脉瘤组之间的血流动力学和几何变量。配对重复100次，计算组合p值并进行调整以进行多重检验。与稳定动脉瘤相比，破裂动脉瘤具有更低的最小WSS （WSSmin, p=0.03）、更高的最大WSS （WSSmax, p=0.03）、更集中的（SCI, p=0.03）和振荡剪应力（OSImean, p=0.03）、更高的最大流速（Vmax, p=0.03）和更复杂的血流（CORELEN, pmax=0.03）。同样，与稳定动脉瘤相比，不稳定动脉瘤具有更集中的剪切应力（SCI, p=0.04）和更复杂的血流（CORELEN, p=0.04）。与稳定动脉瘤相比，破裂动脉瘤更大（SizeRatio, p=0.03），更长（AR, p=0.03），不规则（NSI, p=0.03）。同样，不稳定动脉瘤比稳定动脉瘤更大（SizeRatio, p=0.04），更长（AR, p=0.04），不规则（BL, p=0.04； GAA, p=0.04）。不稳定动脉瘤与破裂动脉瘤之间无显著差异。与动脉瘤位置、患者性别和年龄无关，不稳定动脉瘤和破裂动脉瘤的血流更为复杂，壁剪应力集中，且比稳定动脉瘤更大、更长、不规则。
To identify hostile hemodynamic conditions and geometries that associate with aneurysms instability and rupture, this study compares stable, unstable and ruptured aneurysms while controlling for location and patient characteristics. The hemodynamics and geometries of 165 stable, 65 unstable and 554 ruptured aneurysms were compared. Hemodynamics was modeled using image-based computational fluid dynamics. Case-control pairs were selected matching aneurysm location, patient age and gender. Paired Wilcoxon tests were used to compare hemodynamic and geometric variables between different aneurysm groups. The pairing was repeated 100 times and the combined p-values were calculated and adjusted for multiple testing. Ruptured aneurysms had lower minimum WSS (WSSmin, p=0.03), higher maximum WSS (WSSmax, p=0.03), more concentrated (SCI, p=0.03) and oscillatory shear stress (OSImean, p=0.03), higher maximum velocity (Vmax, p=0.03), and more complex flows (CORELEN, pmax=0.03) than stable aneurysms. Similarly, unstable aneurysms had more concentrated shear stress (SCI, p=0.04), and more complex flows (CORELEN, p=0.04) than stable aneurysms. Compared to stable aneurysms, ruptured aneurysms were larger (SizeRatio, p=0.03), more elongated (AR, p=0.03) and irregular (NSI, p=0.03). Similarly, unstable aneurysms were larger (SizeRatio, p=0.04), more elongated (AR, p=0.04) and irregular (BL, p=0.04; GAA, p=0.04) than stable aneurysms. No significant differences were found between unstable and ruptured aneurysms. Unstable and ruptured aneurysms have more complex flows with concentrated wall shear stress and are larger, more elongated and irregular than stable aneurysms, independently of aneurysm location, patient gender and age.