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： 颅内动脉瘤出现质量效应或毁灭性伤害的巨大风险或 出血。在首次演示时，检测到各种尺寸的动脉瘤。但是，鲜为人知 关于动脉瘤的进展速度随时间的流逝。长期以来一直怀疑血液动力学 在动脉瘤的起源和破裂中发挥重要作用，但据我们所知，没有文献 这证明了动脉瘤的哪些血流动力学描述可以预测未来的增长。 国际对颅内动脉瘤的国际研究的最新结果表明， 尝试修复小于7毫米直径的动脉瘤超过该干预措施的好处。 因此，现在有一群未接受治疗的囊性颅内动脉瘤患者 谁可以随后进行非侵入性成像。这些患者是一组更广泛的患者 颅内循环的动脉瘤，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以每两年一次的基础上监测此类患者 成像。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）模拟以确定血液动力学条件 在每个动脉瘤中。动脉瘤腔体积和/或义务体内血栓的体积随着时间的流逝而进展 将从共同注册的串行成像研究中测量。不同候选人之间的关系 将寻求血液动力学变量和观察到的动脉瘤生长。具体来说，我们假设这一点， 指定低壁剪切应力阈值值，表面积越大，壁剪应力下方 该阈值值越大的是动脉瘤体积随时间的增加。 除了使用已经建立的标准方法外，我们还将开发新的成像功能， 并将在整个血管领域的流速进行更全面的测量 兴趣。我们的CFD方法将扩展到建模非牛顿效应，并在体内速度 测量将用于选择最合适的模型。随着这些新工具的可用 将用于提高我们方法的准确性。该项目代表了翻译研究的努力 针对神经血管疾病的重要组成部分。 公共卫生相关性：这项研究将确定颅内动脉瘤的生长之间的关系 和血液动力学。该信息将用于指导临床医生关于哪些干预治疗 可能会被考虑，并且何时可以最好地实施。