本文選題：3D-TOF-MRA + VR��； 參考：《上海交通大學(xué)》2014年博士論文

【摘要】：第一部分 3.0T3D-TOF MRA對動脈瘤性蛛網(wǎng)膜下腔出血及良性蛛網(wǎng)膜下腔出血的判斷價值：與DSA的對照研究 目的：明確三維時間飛躍磁共振血管造影（3D-TOF-MRA）的容積重建技術(shù)（VR）在檢測顱內(nèi)破裂動脈瘤及診斷良性蛛網(wǎng)膜下腔出血中的準(zhǔn)確性。 方法：對438例自發(fā)性蛛網(wǎng)膜下腔出血病例進(jìn)行前瞻性研究。以2D的數(shù)字減影血管造影和容積再現(xiàn)（3D）的數(shù)字減影血管造影作為診斷的金標(biāo)準(zhǔn)。164個病人被排除在外。根據(jù)VR3D-TOF-MRA獲得患者動脈瘤有無、數(shù)目、位置、大小等指標(biāo)，與DSA結(jié)果對照，計(jì)算出準(zhǔn)確度、靈敏度、特異性、陽性預(yù)測值（PPV）和陰性預(yù)測值（NPV）。將良性蛛網(wǎng)膜下腔出血病例首發(fā)及隨訪VR3D-TOF-MRA結(jié)果與DSA對照，，并根據(jù)陰性預(yù)測值高低，推斷排除性診斷的準(zhǔn)確性。 結(jié)果：在所有274例研究病例中，三維數(shù)字減影血管造影技術(shù)顯示，其中175位病人共有208個動脈瘤（63.9%），99位病人沒有罹患動脈瘤。VR3D-TOF-MRA在以病人為基礎(chǔ)評價的檢測中的準(zhǔn)確度為92.7%、靈敏度97.1％、特異性84.9％、陽性預(yù)測值91.9％和陰性預(yù)測值94.4％。以動脈瘤為基礎(chǔ)評價，其準(zhǔn)確度為90.5%，靈敏度為94.8%，特異性為81.7%，陽性預(yù)測值為91.3%，陰性預(yù)測值為88.5%。且VR3D-TOF-MRA對動脈瘤大小的評價與DSA對照得到了相似的結(jié)論。在25例PNSH及23例cSAH的DSA檢查中，結(jié)果均為陰性。其中1例MRA疑似動脈瘤，經(jīng)DSA檢查得到了排除。 結(jié)論:3.0T VR3D-TOF-MRA準(zhǔn)確檢測出了顱內(nèi)破裂動脈瘤的存在。高陽性預(yù)測值和高陰性預(yù)測值表明：3.0TVR3D-TOF-MRA作為一種無對比性、無創(chuàng)傷、無放射性的診斷手法可能在診斷和篩查顱內(nèi)動脈瘤及判別良性蛛網(wǎng)膜下腔出血方面取代數(shù)字減影血管造影（DSA）。 第二部分 中腦周圍非動脈瘤性蛛網(wǎng)膜下腔出血及后循環(huán)動脈瘤破裂出血的影像學(xué)比較 目的：比較中腦周圍非動脈瘤性蛛網(wǎng)膜下腔出血與后循環(huán)動脈瘤破裂出血的影像學(xué)異同，為蛛網(wǎng)膜下腔出血屬性的早期判斷提供信息。 方法：回顧性分析兩組病例。一組為25例我院2007年1月至2013年12月DSA確診為PNSH的病例。第二組為同期25例DSA證實(shí)后循環(huán)動脈瘤破裂出血病例，比較其一般資料，CT表現(xiàn)（包括部位、累及部位數(shù)）及DSA結(jié)果。兩組患者一般資料無統(tǒng)計(jì)學(xué)差異。 結(jié)果：25例PNSH中位于環(huán)池者20例，鞍上池5例，四疊體池2例，小腦幕2例。DSA均無陽性發(fā)現(xiàn)。25例后循環(huán)動脈瘤，其中基底動脈瘤12例，大腦后動脈瘤5例，椎動脈瘤4例，小腦后下動脈瘤3例，小腦上動脈瘤1例。破裂出血中位于環(huán)池9例，鞍上池8例，四疊體池1例，小腦幕2例，大腦鐮3例，腦溝9例，側(cè)腦室7例，縱裂池3例，側(cè)腦室后角7例，四腦室6例，三腦室3例，腦內(nèi)1例。兩種SAH的好發(fā)部位與累及范圍有明顯差異（P0.05）。兩組患者Hunt-Hess分級及Fisher評分經(jīng)統(tǒng)計(jì)學(xué)計(jì)算亦有明顯統(tǒng)計(jì)學(xué)差異。25例PNSH患者的危險因素經(jīng)Logister回歸分析，認(rèn)為高血壓是其危險因素。 結(jié)論：PNSH與后循環(huán)動脈瘤破裂出血的好發(fā)部位不同，累及范圍較小，預(yù)后好。早期進(jìn)行血管造影是尋找病因的必須手段。 第三部分 破裂或未破裂動脈瘤在動脈瘤形成前后的血液動力學(xué)變化初探 目的：探求采用血管表面修復(fù)技術(shù)模擬動脈瘤生長前的狀態(tài)，對破裂或未破裂動脈瘤在動脈瘤形成前后的血流動力學(xué)變化分析的可行性。 方法：通過腦血管的三維數(shù)字減影血管造影原始圖像采集數(shù)據(jù)，重建得到的顱段頸內(nèi)動脈的幾何形狀，數(shù)據(jù)建模后，利用基于三維體積的有限元模型，分別在“有瘤”和“去瘤”狀態(tài)下，進(jìn)行流體力學(xué)仿真分析。對動脈瘤瘤體內(nèi)部以及動脈瘤形成位點(diǎn)的血流動力參數(shù)，如壁面切應(yīng)力（WWS)，血流速度，流線，管壁壓力，以及壁面切應(yīng)力梯度（WSSG)進(jìn)行分析。 結(jié)果：在“有瘤”的情況下，對動脈瘤頸、動脈瘤體和動脈瘤頂?shù)难鲃恿W(xué)研究分析表明，在兩種模型中，遠(yuǎn)端動脈瘤頸承受的壁面切應(yīng)力（WWS)最大且血流速度最快，而動脈瘤頂承受的壁面切應(yīng)力（WWS)最小且血流速度最慢。僅在破裂的后交通動脈動脈瘤模型中發(fā)現(xiàn)有射流和狹窄沖擊閾的存在，并且動脈瘤頂部的管壁切應(yīng)力梯度（WSSG)具有更為顯著的改變。在兩種模型下的血流動力分析都表明，處于動脈瘤形成前的“去瘤”狀態(tài)下，動脈瘤形成區(qū)域承受著急劇升高的管壁切應(yīng)力、切應(yīng)力梯度以及急劇升高的血流速度。 結(jié)論：實(shí)驗(yàn)數(shù)據(jù)表明，運(yùn)用血管表面修復(fù)方法對患者已破裂的動脈瘤或未破裂的動脈瘤進(jìn)行血流動力分析是可行的、經(jīng)濟(jì)且簡易的。我們的初步結(jié)果顯示，在動脈瘤形成之前，動脈壁承受著較大的壁面切應(yīng)力（WWS)，較高的壁面切應(yīng)力梯度（WSSG)和較快的血流速度。然而，在破裂的動脈瘤中，可能觀察到更加復(fù)雜的流動方式（如射流和狹窄沖擊閾）。
[Abstract]:the first portion

The diagnostic value of 3.0 T3D - TOF MRA in the diagnosis of smal subarachnoid hemorrhage and benign subarachnoid hemorrhage : a comparative study with DSA

Objective : To determine the accuracy of 3D - TOF - MRA in detecting intracranial ruptured aneurysms and diagnosing benign subarachnoid hemorrhage .

Methods : A prospective study of 438 cases of spontaneous subarachnoid hemorrhage was performed . The digital subtraction angiography and volume rendering ( 3D ) of 2D digital subtraction angiography were used as the diagnostic gold standard . 164 patients were excluded . The accuracy , sensitivity , specificity , positive predictive value ( PPV ) and negative predictive value ( NPV ) were calculated based on the results of VR3D - TOF - MRA . The accuracy , sensitivity , specificity , positive predictive value ( PPV ) and negative predictive value ( NPV ) were calculated .

Results : In all 274 cases , 208 aneurysms ( 63.9 % ) were found in 175 patients , and 99 patients had no aneurysm . The accuracy of VR3D - TOF - MRA was 90.5 % , sensitivity 97.1 % , specificity 84.9 % , positive predictive value 91.9 % and negative predictive value 94.4 % .

Conclusion : 3 . 0T VR3D - TOF - MRA accurately detects the presence of ruptured intracranial aneurysms . High positive predictive value and high negative predictive value indicate that 3.0 TVR3D - TOF - MRA is a non - contrast , non - invasive , non - radioactive diagnostic technique that may replace digital subtraction angiography ( DSA ) in the diagnosis and screening of intracranial aneurysms and the identification of benign subarachnoid hemorrhage .

the second part

Imaging comparison of hemorrhage of non - aneursmal subarachnoid hemorrhage and ruptured posterior circulation aneurysm in the midbrain

Objective : To compare the imaging differences between the hemorrhage of non - aneursmal subarachnoid hemorrhage and the ruptured intracranial aneurysm in the middle cerebral cortex and to provide information for the early diagnosis of subarachnoid hemorrhage .

Methods : A group of 25 cases with PNSH diagnosed by DSA from January 2007 to December 2013 were analyzed retrospectively , and the general data , CT manifestations ( including the number of parts and parts ) and DSA results were compared between the two groups .

Results : In 25 patients with PNSH , 20 cases were located in the ring cell , 5 in the saddle , 2 in the tetrad pool and 2 in the cerebellum . There were 12 cases of basilar artery aneurysm , 5 cases of posterior cerebral aneurysm , 4 cases of vertebral artery aneurysm , 3 cases of posterior inferior cerebral aneurysm , 6 cases of posterior cerebral aneurysm , 3 cases of posterior cerebral aneurysm , 3 cases of posterior cerebral aneurysm , 6 cases of posterior cerebral aneurysm , 3 cerebral ventricle , 3 cases of cerebral falx , 3 cases of posterior horn of cerebral ventricle , 6 cases of posterior cerebral aneurysm , 3 cerebral ventricle , 3 cases of cerebral falx , 3 cases of posterior cerebral aneurysm , 6 cases of posterior cerebral aneurysm , 3 cerebral ventricle , 3 cases of cerebral falx , 3 cases of posterior cerebral aneurysm , 6 cases of posterior cerebral aneurysm , 3 cerebral ventricle , 3 cases of cerebral falx , 3 cases of posterior cerebral aneurysm , 6 cases of posterior cerebral aneurysm , 3 cases of cerebral aneurysms , 3 cases of cerebral falx , 3 cases of posterior cerebral aneurysm , 6 cases of cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysm , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 1 case of cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of cerebral falx , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 9 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 9 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of cerebral falx , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of cerebral falx , 3 cases of posterior cerebral aneurysms , 3 cases of cerebral aneurysms , 3 cases of

Conclusion : Both PNSH and posterior circulation aneurysm can be used as a necessary means of finding the cause of rupture of ruptured intracranial aneurysms .

PART III

A preliminary study on hemodynamic changes of ruptured or unruptured aneurysms before and after aneurysm formation

Objective : To explore the feasibility of using vascular surface repair technique to simulate the state of aneurysm before and after aneurysm formation .

Methods : The geometric shape and data modeling of the internal carotid artery were reconstructed by three - dimensional digital subtraction angiography of cerebral vessels . After data modeling , fluid dynamics simulation was carried out on the basis of three - dimensional volume - based finite element model . The parameters of hemodynamics , such as wall shear stress ( WWS ) , blood flow velocity , flow line , wall pressure , and wall shear stress gradient ( Wssg ) were analyzed .

Results : In the case of " tumor " , the hemodynamic study of the aneurysm neck , aneurysm body and aneurysm roof showed that the wall shear stress ( WWS ) of the distal aneurysm neck was the largest and the blood flow velocity was the fastest in both models . The wall shear stress ( WWS ) at the top of the aneurysm was minimal and the blood flow velocity was the slowest .

Conclusions : Experimental data suggest that the use of vascular surface repair methods is feasible , economical and simple to perform hemodynamic analysis of ruptured aneurysms or unruptured aneurysms in patients . Our preliminary results suggest that , before aneurysm formation , the arterial wall is subjected to a large wall shear stress ( WWS ) , a higher wall shear stress gradient ( Wssg ) , and a faster flow velocity . However , in ruptured aneurysms , a more complex flow regime ( e.g . jet and narrow impact threshold ) may be observed .
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R743.35;R445.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 張鶴;李明華;方淳;李文彬;吳春根;程英升;;3.0T時間飛躍法MRA診斷顱內(nèi)動脈瘤—與DSA對照[J];介入放射學(xué)雜志;2008年09期

2 周良;董其龍;陳自謙;;MRA與DSA血管成像對腦血管疾病的診斷價值[J];江蘇醫(yī)藥;2007年12期

本文編號：2031555