Determinants of Intracranial Aneurysm Growth

颅内动脉瘤生长的决定因素

• 批准号: 8209178
• 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/8209178
• 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; 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; abstracting; base; clinical decision-making; cohort; effective intervention; experience; hemodynamics; improved; in vivo; insight; interest; particle; predictive modeling; public health relevance; repaired; residence; shear stress; simulation; tool; vector

Abstract: 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 intralumenal 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 an 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.

抽象的： 颅内动脉瘤存在巨大的死亡或毁灭性伤害的风险，无论是由于质量效应还是 出血。首次就诊时可检测到各种尺寸的动脉瘤。然而，鲜为人知 关于动脉瘤随时间的进展速度。长期以来人们一直怀疑血流动力学 在动脉瘤的发生和破裂中发挥重要作用，但据我们所知，没有文献 这表明动脉瘤的哪些血流动力学描述符可以预测未来的生长。 国际未破裂颅内动脉瘤研究的最新结果表明， 尝试修复直径小于 7 毫米的动脉瘤超出了该干预措施的益处。 因此，现在有一群患有囊状颅内动脉瘤的患者没有接受治疗， 以及谁可以接受非侵入性成像跟踪。这些患者是更广泛的患者群体的一部分 颅内循环动脉瘤，目前尚无安全有效的干预措施。 该项目的目标是每两年通过非侵入性磁共振监测此类患者 成像。使用从患者特定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) 模拟以确定血流动力学条件 在每个动脉瘤中。动脉瘤腔体积和/或腔内血栓体积随时间的进展 将通过联合注册的连续成像研究进行测量。不同候选人之间的关系 将寻求血流动力学变量和观察到的动脉瘤生长。具体来说，我们假设， 指定较低的壁面剪应力阈值，壁面剪应力低于该值时表面积越大 该阈值越大，动脉瘤体积随着时间的推移而增加。 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， 并将对整个血管区域的流速进行更全面的测量 兴趣。我们的 CFD 方法将扩展到模拟非牛顿效应和体内速度 测量结果将用于选择最合适的模型。随着这些新工具的出现，它们 将用于提高我们方法的准确性。该项目代表了转化研究的努力 针对神经血管疾病的一个重要组成部分。 公共健康相关性：这项研究将确定颅内动脉瘤生长之间的关系 和血流动力。该信息将用于指导临床医生进行哪些介入治疗 可能会被考虑，以及何时可以最好地实施。