Patient-Specific Coronary Hemodynamics by 3D Printing

抽象的。尽管针对减轻疾病负担的治疗方法有所改进，但冠心病仍在困扰着 &gt；1600万美国成年人，占所有死亡人数的三分之一以上，约120万人 每年住院治疗。冠状动脉血运重建仍然是冠心病治疗的主要手段，使用&gt；1.2 在美国，每年进行100万次经皮介入治疗。之前的多中心试验已经证明 部分血流引导下血管重建术的患者预后良好 储备(FFR)--确定冠状动脉狭窄的生理意义的侵入性“黄金”标准。 最近，我们研究了一种基于CT的非侵入性替代FFR的方法，称为FFRCT。 虽然这种新方法具有一定的精确度，但它有几个限制，例如假设 冠脉是坚硬的，血流是非搏动性的。因此，我们已经确定了另一种方法来 通过3D打印评估冠状动脉血流动力学，允许对冠状动脉血流进行物理测量 使用真实的组织力学和脉动流。在此应用程序中，我们将优化硬件、软件、 工作流程，以及基于患者CT图像建立和评估冠状动脉血流动力学的分析。 将使用广泛的临床成像数据，包括150-H2O标记的PET成像来验证 这些用于预测冠状动脉血流动力学的模型。最后，这些3D打印模型将被用于开发 临床有用的报告，可以提供诊断确定的患者的缺血程度仅使用 无创CT成像。

ABSTRACT. Despite improvements in therapies targeted at reducing disease burden, CAD continues to afflict >16 million US adults, accounting for more than 1/3 of all deaths and responsible for ~1.2 million hospitalizations annually. Coronary revascularization remains a mainstay of treatment for CAD, with >1.2 million percutaneous interventions performed annually in the US. Prior multicenter trials have demonstrated propitious outcomes for individuals with who undergo ischemia-guided revascularization by fractional flow reserve (FFR)—an invasive “gold” standard that determines the physiologic significance of coronary stenoses. More recently we have studied the accuracy of a non-invasive CT-based alternative to FFR, termed FFRCT. While this new method is moderately accurate, it possesses several limitations such as assuming the walls of the coronaries are rigid and flow is non-pulsatile. Therefore, we have determined an alternative approach to assessing coronary hemodynamics via 3D printing, which allows physical measurements of coronary flow using realistic tissue mechanics and pulsatile flow. In this application, we will optimize the hardware, software, workflows, and analysis to build and evaluate coronary hemodynamics based on patient CT images. Extensive clinical imaging data, including 15O-H2O labeled PET imaging will be used to validate the accuracy of these models for predicting coronary hemodynamics. Finally, these 3D printed models will be used to develop clinically useful reports that can provide diagnostic determination of a patient's level of ischemia using only non-invasive CT imaging.