基于CT影像组学和计算流体力学的斑块形态学特征在冠状动脉解剖狭窄与心肌缺血不匹配中的作用及机制研究

研究证实冠心病的冠状动脉狭窄程度与心肌缺血不完全匹配，即重度狭窄不一定缺血，而中度甚至轻度狭窄却可致心肌缺血。这可造成不必要的血运重建术或延误手术造成严重后果，故探究不匹配原因具有重要的临床意义。血流储备分数(FFR)是评估缺血性狭窄的金标准，最新研究显示斑块的CT形态学特征可影响FFR值，即相同狭窄程度下斑块的形态学特征可能是造成心肌缺血与否的关键因素。新兴的影像组学对比常规影像方法可高通量提取病变的形状、纹理、小波等多维信息，为精准研究斑块形态学特征对缺血性狭窄的潜在影响提供了可能。本研究拟基于冠状动脉CT图像，以FFR为标准，通过影像组学得到不同狭窄程度下致心肌缺血的斑块关键组学特征，据此构建含有斑块特征的计算流体力学仿真狭窄模型，并以模拟FFR验证其准确性。最终明确冠状动脉解剖狭窄与心肌缺血不匹配的潜在原因及可能机制，为冠心病和缺血性狭窄的无创精准诊断提供新方法。

Many works have shown that the coronary artery stenosis is not completely consistent with myocardial ischemia. Severe stenosis does not necessarily lead to myocardial ischemia, while moderate or even mild stenosis does. This mismatch may lead to invalid revascularization or delayed percutaneous coronary intervention and adverse clinical outcomes. To evaluate the underlying reasons and mechanism is of great clinical significance. Recent studies have shown that CT morphological features of plaques may influence the FFR value, which suggested that different morphological characteristics of plaques may be the key factor for myocardial ischemia at the same stenosis. Compared with conventional imaging methods, the novel radiomics technology has the ability to extract the shape, texture, wavelet and other multidimensional morphological features of plaques with high throughput, which provides a possibility for accurate study of the potential effect of plaque morphological features on myocardial ischemia. This study intend to get different CT radiomics characteristics of plaques in different stenosis based on coronary CT images. Based on these characteristics, the computational fluid dynamics model is simulated and constructed, and the accuracy is also verified by FFR results. The underlying causes and possible mechanisms of the mismatch between coronary artery anatomic stenosis and myocardial ischemia may correspondingly be identified. This study may provide a new method for noninvasive accurate diagnosis of coronary heart disease and ischemic stenosis.