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        顱內(nèi)動(dòng)脈瘤夾閉手術(shù)的數(shù)值模擬與臨床應(yīng)用研究

        2019-10-08 06:27:21胡鈞浛王汝良胡霖霖
        軟件 2019年6期
        關(guān)鍵詞:計(jì)算流體力學(xué)顱內(nèi)動(dòng)脈瘤血流動(dòng)力學(xué)

        胡鈞浛 王汝良 胡霖霖

        摘 ?要: 本文使用計(jì)算流體力學(xué)(CFD)的方法對(duì)顱內(nèi)動(dòng)脈瘤夾閉手術(shù)前后以及正常血管進(jìn)行數(shù)值模擬。通過(guò)使用Mimics、3-matic對(duì)CT數(shù)據(jù)進(jìn)行重建,再使用Ansys進(jìn)行網(wǎng)格劃分、求解計(jì)算,獲得模擬夾閉手術(shù)前后的心動(dòng)周期不同時(shí)刻的血流速度、壁切應(yīng)力、壁壓力數(shù)值。數(shù)值模擬改變血流動(dòng)力學(xué)的方式可以對(duì)動(dòng)脈瘤治療前及治療后的狀況進(jìn)行評(píng)估。動(dòng)脈瘤處的低壁切應(yīng)力和低速區(qū)域與動(dòng)脈瘤破裂有關(guān)。

        關(guān)鍵詞: 顱內(nèi)動(dòng)脈瘤;計(jì)算流體力學(xué);血流動(dòng)力學(xué);夾閉手術(shù)

        中圖分類號(hào): TP319 ? ?文獻(xiàn)標(biāo)識(shí)碼: A ? ?DOI:10.3969/j.issn.1003-6970.2019.06.009

        本文著錄格式:胡鈞浛,王汝良,胡霖霖,等. 顱內(nèi)動(dòng)脈瘤夾閉手術(shù)的數(shù)值模擬與臨床應(yīng)用研究[J]. 軟件,2019,40(6):4043+63

        【Abstract】: Computational fluid mechanics(CFD) method was used to simulate intracranial aneurysms before and after operation and normal blood vessels. Through the reconstruction of CT data using Mimics and 3-matic, and then using Ansys for mesh division and calculation, the blood flow velocity, wall shear stress, and wall pressure values at different times of the cardiac cycle before and after the simulated clamping operation are obtained. Numerical simulations of changes in hemodynamics can assess the status of aneurysms before and after treatment. The low wall shear stress and the low velocity area at the aneurysm are related to the rupture of the aneurysm.

        【Key words】: Intracranial aneurysm; Computational fluid mechanics; Hemodynamics; Folding surgery

        0 ?引言

        顱內(nèi)動(dòng)脈瘤(intracranial aneurysm,IA)是顱內(nèi)動(dòng)脈管壁上局部的、球囊樣的異常膨出[1]。顱內(nèi)動(dòng)脈瘤在普通人群的患病率為3-5%,在診斷后5年內(nèi),總體破裂風(fēng)險(xiǎn)為1.2%[2-4]。血流動(dòng)力學(xué)對(duì)顱內(nèi)動(dòng)脈瘤的形成和發(fā)展過(guò)程中起到了非常重要的作用[5,6],可以通過(guò)改變血流動(dòng)力學(xué)來(lái)限制動(dòng)脈瘤的繼續(xù)發(fā)展甚至破裂。計(jì)算流體力學(xué)(computational fluid dynamics,CFD)對(duì)血流動(dòng)力學(xué)的研究取得重大進(jìn)展[7-9]。本研究將應(yīng)用計(jì)算流體力學(xué)的方法對(duì)一例顱內(nèi)動(dòng)脈瘤進(jìn)行模擬夾閉手術(shù)并將其與夾閉手術(shù)前和同一位置的正常血管的血流動(dòng)力學(xué)進(jìn)行對(duì)比。

        1 ?材料與方法

        1.1 ?原始數(shù)據(jù)采集

        采集牡丹江醫(yī)學(xué)院附屬紅旗醫(yī)院1例男性顱內(nèi)CTA影像數(shù)據(jù),年齡47歲,采用日本東芝Aquilion64層螺旋CT,掃描參數(shù):管電壓120 KV、管電流 ? 250 mA、掃描矩陣512×512、像素尺寸0.481 mm、掃描層厚0.5 mm,以4.0 mL/s經(jīng)肘靜脈注射造影劑150 mL,要求患者在掃描過(guò)程中不做吞咽動(dòng)作,掃描數(shù)據(jù)以DICOM(Digital imaging and Communica?tions in Medicine)格式儲(chǔ)存。

        1.2 ?實(shí)驗(yàn)設(shè)備

        戴爾Precision T7810:Xeon E5-2609 v3處理器、16 G內(nèi)存、nVIDIA Quadro2200顯卡。

        1.3 ?實(shí)驗(yàn)應(yīng)用軟件

        Mimics 20.0;3-matic 12.0;Ansys workbench 18.0。

        1.4 ?有限元模型的建立

        1.4.1 ?模型的三維重建及修復(fù)

        將CTA影像數(shù)據(jù)導(dǎo)入Mimics20.0軟件,采用使用閾值分割(Thresholding)、區(qū)域增長(zhǎng)(Region Growing)、蒙板編輯(Edit Masks)等獲得感興趣區(qū)域,去除細(xì)小分支,再通過(guò)計(jì)算三維工具(Calculate Part)對(duì)感興趣區(qū)域進(jìn)行三維重建,在3-matic中對(duì)模型進(jìn)行光滑處理,以stl格式保存重建的模型。正常血管為模型Ⅰ,夾閉手術(shù)前為模型Ⅱ,夾閉手術(shù)后為模型Ⅲ。

        1.4.2 ?網(wǎng)格劃分及數(shù)值模擬

        在Ansys ICEM CFD中對(duì)動(dòng)脈瘤進(jìn)行網(wǎng)格劃分(圖1)。

        將血流設(shè)定為牛頓流體且為層流,設(shè)置血液密度為1060 kg/m3,粘度為0.0035Pas[10,11]。設(shè)定動(dòng)脈瘤壁為剛性,血液和血管壁面無(wú)滑動(dòng)及滲透。入口給與脈動(dòng)速度(圖2),出口處的壓力設(shè)定為0。

        血流速度為脈動(dòng)血流,心動(dòng)周期均為0.8 s,步長(zhǎng)為0.01 s,總共計(jì)算200步。計(jì)算兩個(gè)周期,以0.88 s、1 s、1.1 s時(shí)刻的結(jié)果進(jìn)行分析。

        2 ?數(shù)值模擬結(jié)果分析

        2.1 ?血流速度

        圖3是三個(gè)模型分別在0.88 s、1 s、1.1 s三個(gè)時(shí)刻的血流速度流線圖。從模型Ⅱ中可以看出,載瘤動(dòng)脈中心血流速度不斷降低,血流狀態(tài)為層流。血液在動(dòng)脈瘤中形成渦流,隨著血流速度的降低,瘤腔內(nèi)的血流反而增多,遠(yuǎn)離瘤腔中心部位的血流速度更低。模型Ⅲ與模型Ⅱ相比,原瘤腔部位的血流已經(jīng)消失。模型Ⅱ、Ⅲ與模型Ⅰ相比,同一時(shí)刻的血流速度要高。

        2.2 ?壁切應(yīng)力

        圖4是三個(gè)模型分別在0.88 s、1 s、1.1 s三個(gè)時(shí)刻的壁切應(yīng)力圖。三種模型的壁切應(yīng)力隨著血流速度的降低均有所下降。模型Ⅱ的瘤壁始終保持在低壁切應(yīng)力狀態(tài),瘤頸部的壁切應(yīng)力隨血流速度的降低逐漸降低。模型Ⅱ和模型Ⅲ比較,除了動(dòng)脈瘤部分外未發(fā)生明顯變化。模型Ⅰ整體的壁切應(yīng)力低于模型Ⅱ和模型Ⅲ。

        2.3 ?壁壓力

        圖5是三個(gè)模型分別在0.88 s、1 s、1.1 s三個(gè)時(shí)刻的壁壓力圖。在0.88 s,模型Ⅱ和模型Ⅲ入口處的壓力明顯高于模型Ⅰ。模型Ⅱ和模型Ⅲ除了動(dòng)脈瘤部分,各處壓力值也未有沒(méi)有變化。模型Ⅱ和模型Ⅲ的壁壓力整體高于模型Ⅰ。

        3 ?討論

        本文采用數(shù)值模擬的方法對(duì)動(dòng)脈瘤夾閉前、夾閉后以及正常血管的血流動(dòng)力學(xué)參數(shù)進(jìn)行對(duì)比分析。對(duì)比后發(fā)現(xiàn),夾閉后動(dòng)脈瘤內(nèi)沒(méi)有血流,夾閉前動(dòng)脈瘤內(nèi)血流豐富、渦流,但流速較慢。夾閉前后血管的血流速度高于正常血管。夾閉前的動(dòng)脈瘤壁切應(yīng)力處于低的狀態(tài),壁壓力較高。Lu等人[12]和Xiang[13]等人發(fā)現(xiàn)破裂組的動(dòng)脈瘤的平均WSS要比未破裂組低。Liu等人[14]的研究中評(píng)估了動(dòng)脈瘤破裂前的血流動(dòng)力學(xué)特征,發(fā)現(xiàn)了低WSS與未破裂動(dòng)脈瘤破裂有關(guān)。低WSS同時(shí)會(huì)導(dǎo)致血管壁發(fā)生變化,從而進(jìn)一步導(dǎo)致了血管壁的破裂[15]。Jou等[16]和Acevedo-Bolton等[17]研究發(fā)現(xiàn)低WSS和動(dòng)脈瘤生長(zhǎng)之間的相關(guān)性。Meng[18]等人研究表明低WSS和高震蕩剪切指數(shù)與大的動(dòng)脈粥樣硬化性動(dòng)脈瘤表型的生長(zhǎng)和破裂有關(guān),而高WSS和正的WSS梯度與小的或繼發(fā)性囊性動(dòng)脈瘤表型的生長(zhǎng)和破裂有關(guān)。Wang[19]等人建立虛擬支架植入術(shù)CFD仿真模型,模擬了15例動(dòng)脈瘤支架植入,結(jié)果表明血流速度和WSS在不同類型的動(dòng)脈瘤均降低。而我們所模擬的是夾閉術(shù),直接讓動(dòng)脈瘤排除在血液循環(huán)之外,通過(guò)將其排除在血液循環(huán)之外,可以避免動(dòng)脈瘤的繼續(xù)發(fā)展甚至破裂。

        4 ?結(jié)論

        本研究的目的是探討動(dòng)脈瘤夾閉術(shù)前后的血流動(dòng)力學(xué)特征,我們對(duì)夾閉術(shù)前后以及正常血管基于CT影像數(shù)據(jù)的進(jìn)行了計(jì)算流體力學(xué)模擬。通過(guò)數(shù)值模擬改變血流動(dòng)力學(xué)的方式可以對(duì)動(dòng)脈瘤治療前及治療后的狀況進(jìn)行評(píng)估。動(dòng)脈瘤處的低壁切應(yīng)力和低速區(qū)域與動(dòng)脈瘤破裂有關(guān)。

        參考文獻(xiàn)

        [1] Seo, J., et al., A Highly Automated Computational Method for Modeling of Intracranial Aneurysm Hemodynamics. Frontiers in Physiology, 2018. 9: 681.

        [2] Bonneville F, Sourour N, Biondi A. Intracranial Aneurysms: an Overview. Neuroimaging Clinics of North America. 2006; 16(3): 371-382.

        [3] Keedy A. An overview of intracranial aneurysms. McGill Journal of Medicine. 2006; 9(2): 141-146.

        [4] Wermer MJH, Van Der Schaaf IC, Algra A, Rinkel GJE. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: An updated meta- analysis. Stroke. 2007; 38 (4): 1404-1410.

        [5] Lasheras JC. The biomechanics of arterial aneurysms. Annual Review of Fluid Mechanics. 2007; 39: 293-319.

        [6] Sforza DM, Putman CM, Cebral JR. Hemodynamics of cerebral aneurysms. Annual Review of Fluid Mechanics. 2009; 41: 91-107.

        [7] Miura Y, Ishida F, Umeda Y, Tanemura H, Suzuki H, Matsushima S, et al. Low wall shear stress is independently associated with the rupture status of middle cerebral artery aneurysms. Stroke. 2013; 44(2): 519-521.

        [8] Fukazawa K, Ishida F, Umeda Y, Miura Y, Shimosaka S, Matsushima S, et al. Using computational fluid dynamics analysis to characterize local hemodynamic features of middle cerebral artery aneurysm rupture points. World Neurosurg. 2015; 83(1): 80-86.

        [9] Tsuji M, Ishikawa T, Ishida F, Furukawa K, Miura Y, Shiba M, et al. Stagnation and complex flow in ruptured cerebral aneurysms: a possible association with hemostatic pattern. J Neurosurg. 2016; 3: 1-7.

        [10] Hua, Y., J. H. Oh and Y. B. Kim, Influence of Parent Artery Segmentation and Boundary Conditions on Hemodynamic Characteristics of Intracranial Aneurysms. Yonsei Medical Journal, 2015. 56(5): p. 1328.

        [11] Paliwal, N., et al., Association between hemodynamic modifications and clinical outcome of intracranial aneurysms treated using flow diverters. Proc SPIE Int Soc Opt Eng, 2017. 10135.

        [12] Lu G, Huang L, Zhang XL, Wang SZ, Hong Y, Hu Z, et al. Influence of hemodynamic factors on rupture of intracranial aneurysms: patient-specific 3D mirror aneurysms model computational fluid dynamics simulation. AJNR American journal of neuroradiology. 2011; 32(7): 1255-61.

        [13] Xiang J, Natarajan SK, Tremmel M, Ma D, Mocco J, Hopkins LN, et al. Hemodynamic-morphologic discriminants for intracranial aneurysm rupture. Stroke; a journal of cerebral circulation. 2011; 42(1): 144-52.

        [14] Liu J, Fan J, Xiang J, Zhang Y, Yang X. Hemodynamic characteristics of large unruptured internal carotid artery aneurysms prior to rupture: a case control study. J Neurointerv Surg. 2016; 8: 367-72.

        [15] Pentimalli L, Modesti A, Vignati A, Marchese E, Albanese A, Di Rocco F, Coletti A, Di Nardo P, Fantini C, Tirpakova B, Maira G. Role of apoptosis in intracranial aneurysm rupture. J Neurosurg. 2004;101: 1018-25.

        [16] Jou LD, Wong G, Dispensa B, et al. Correlation between luminal geometry changes and hemodynamics in fusiform intracranial aneurysms. AJNR Am J Neuroradiol 2005;26: 2357-63.

        [17] Acevedo-Bolton G, Jou LD, Dispensa BP, et al. Estimating the hemodynamic impact of interventional treatments of aneurysms: numerical simulation with experimental validation: technical case report. Neurosurgery 2006;59: E429-30.

        [18] Meng H, Tutino VM, Xiang J, Siddiqui A. High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis. AJNR. American journal of neuroradiology. 2014; 35: 1254-1262.

        [19] Wang, C., et al., Hemodynamic alterations after stent implantation in 15 cases of intracranial aneurysm. Acta Neurochirurgica, 2016. 158(4): p. 811-819.

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