Determinants of Intracranial Aneurysm Growth

颅内动脉瘤生长的决定因素

• 批准号: 8009483
• 负责人: David A Saloner
• 金额: $ 33.12万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-01 至 2013-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8009483
• 关键词: Address; Anatomy; Aneurysm; Angiography; Area; Berry Aneurysm; Blood Circulation; Blood Vessels; Blood flow; Brain; Caliber; Cephalic; Cessation of life; Clinical; Computing Methodologies; Coupled; Decision Making; Descriptor; Disease; EFRAC; Endothelium; Evaluation; Favorable Clinical Outcome; Future; Goals; Growth; Health; Heart Diseases; Hemorrhage; Image; Individual; Injury; International; Intervention; Intracranial Aneurysm; Investigation; Liquid substance; Literature; Location; Magnetic Resonance Imaging; Maps; Measurement; Measures; Methodology; Methods; Mitral Valve; Modeling; Monitor; Natural History; Neurosurgeon; Outcome; Patient Monitoring; Patients; Play; Qualifying; Relative (related person); Resolution; Risk; Role; Rupture; Ruptured Aneurysm; Specific qualifier value; Surface; Techniques; Testing; Thrombus; Time; Translational Research; base; clinical decision-making; cohort; effective intervention; experience; hemodynamics; improved; in vivo; insight; interest; particle; predictive modeling; repaired; residence; shear stress; simulation; tool; vector

DESCRIPTION (provided by applicant): Intracranial aneurysms present a formidable risk of death or devastating injury either from mass effect or hemorrhage. Aneurysms are detected with a broad range of sizes on first presentation. However, little is known about the rate of progression of aneurysms over time. It has long been suspected that hemodynamic forces play an important role in the genesis and rupture of aneurysms, but there is, to our knowledge, no literature that demonstrates which hemodynamic descriptors of an aneurysm are predictive of future growth. Recent results from the International Study of Unruptured Intracranial Aneurysms demonstrate that the risk of attempting a repair of aneurysms smaller than 7 mm in diameter exceeds the benefit from that intervention. There is now, therefore, a group of patients with saccular intracranial aneurysms who are not being treated, and who can be followed by non-invasive imaging. These patients are part of a broader group of patients with aneurysms of the intracranial circulation for whom there are no safe and effective interventions. The goal of this project is to monitor such patients on a bi-annual basis with non-invasive Magnetic Resonance Imaging. Using boundary values (geometric and velocity) obtained from patient-specific in-vivo imaging, Computational Fluid Dynamics (CFD) simulations will be performed to determine the hemodynamic conditions in each aneurysm. Progression over time in aneurysm lumen volume and/or volume of intraluminal thrombus will be measured from co-registered serial imaging studies. A relationship between different candidate hemodynamic variables and observed aneurysm growth will be sought. Specifically, we hypothesize that, specifying a low wall shear stress threshold value, the larger the surface area is with wall shear stress below that threshold value the greater will be the increase in aneurysm volume over time. In addition to using the standard methodology already established, we will develop new imaging capabilities, and will implement more comprehensive measurements of flow velocities throughout the vascular territory of interest. Our CFD methods will be extended to model non-Newtonian effects, and the in-vivo velocity measurements will be used to select which model is most suitable. As these new tools become available they will be used to improve the accuracy of our methods. This project represents an effort in translational research directed at a important component of neurovascular disorders. PUBLIC HEALTH RELEVANCE: This study will determine the relationship between growth of intracranial aneurysms and hemodynamic forces. That information will be used to guide clinicians as to what interventional treatments might be considered, and when they might best be implemented. The project will provide insight into the underlying mechanisms of aneurysm progression and could help in guiding treatment for this devastating condition.

描述（由申请人提供）：颅内动脉瘤具有严重的死亡风险或质量效应或出血造成的毁灭性伤害。在首次演示时，检测到各种尺寸的动脉瘤。但是，随着时间的流逝，动脉瘤的进展速率知之甚少。长期以来，人们一直怀疑血液动力学在动脉瘤的起源和破裂中起着重要作用，但据我们所知，没有文献证明动脉瘤的血液动力学描述者可以预测未来的生长。国际对颅内动脉瘤的国际研究的最新结果表明，尝试修复直径小于7毫米的动脉瘤的风险超过了该干预措施的益处。因此，现在有一组未接受治疗的颅内动脉瘤患者，可以随后进行非侵入性成像。这些患者是颅内循环的较广泛患者的一部分，没有安全有效的干预措施。该项目的目的是通过非侵入性磁共振成像每两年一次监测此类患者。使用从患者特异性体内成像获得的边界值（几何和速度），将进行计算流体动力学（CFD）模拟，以确定每个动脉瘤的血液动力学条件。动脉瘤腔体积的进展和/或腔内血栓的体积将通过共注册的串行成像研究来测量。将寻求不同候选血液动力学变量与观察到的动脉瘤生长之间的关系。具体而言，我们假设指定低壁剪切应力阈值值，表面积的越大，壁剪应力低于该阈值，则越越大，随着时间的推移，动脉瘤体积的增加将越大。除了使用已经建立的标准方法之外，我们还将开发新的成像功能，并将对整个感兴趣的血管领域进行更全面的流速测量。我们的CFD方法将扩展到建模非牛顿效应，并将使用体内速度测量值来选择哪种模型最合适。随着这些新工具的可用，它们将用于提高我们方法的准确性。该项目代表了针对神经血管疾病重要组成部分的转化研究的努力。公共卫生相关性：这项研究将确定颅内动脉瘤和血液动力学的生长之间的关系。该信息将用于指导临床医生，以了解可以考虑哪些干预治疗以及何时可以实施临床治疗。 该项目将洞悉动脉瘤进展的潜在机制，并有助于指导这种毁灭性疾病的治疗。