【摘要】：目的:以癥狀性大腦中動(dòng)脈(MCA)斑塊的活體高分辨率磁共振成像(HR-MRI)數(shù)據(jù)為基礎(chǔ),建立3D完全耦合的流-固耦合(FSI)模型,探索不同組分MCA斑塊的生物力學(xué)特征。方法:研究對(duì)象為擬行介入手術(shù)治療的12例癥狀性單側(cè)MCA局限性動(dòng)脈粥樣硬化狹窄的患者。首先,術(shù)前對(duì)MCA管壁行HR-MRI作為力學(xué)建模的形態(tài)學(xué)依據(jù);其次,利用相位對(duì)比MRI技術(shù)和DSA引導(dǎo)下的測(cè)壓微導(dǎo)管分別采集MCA狹窄前端的血流參數(shù)和血壓數(shù)據(jù)作為載荷條件,并對(duì)目標(biāo)血管的3D幾何結(jié)構(gòu)進(jìn)行網(wǎng)格生成等前處理,導(dǎo)入有限元程序軟件ADINA(ADINA RD,Inc,USA)進(jìn)行FSI求解;最后,從3D FSI結(jié)果中提取3個(gè)力學(xué)指標(biāo)值:最大主應(yīng)力(MPS)、最大主伸長(zhǎng)比(STRETCH-P1)和最大剪應(yīng)力(FMSS),分析比較不同狹窄程度和不同斑塊成分的各項(xiàng)力學(xué)指標(biāo)的差異。結(jié)果:按照狹窄率分組比較發(fā)現(xiàn),輕中度狹窄組的MPS、STRETCH-P1和FMSS與重度狹窄組之間的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.9323、0.3872和0.1271)。分析不同斑塊成分發(fā)現(xiàn),含"脂質(zhì)核心"斑塊的層面中MPS稍高于含"纖維成分"斑塊(P=0.0744),STRETCH-P1明顯高于"纖維成分"斑塊(P=0.0169),FMSS顯著低于"纖維成分"斑塊(P=0.0021)。結(jié)論:癥狀性MCA粥樣硬化病變中,"脂質(zhì)核心"斑塊的主應(yīng)力和主伸長(zhǎng)比均不同程度地高于"纖維化"斑塊,提示富含脂質(zhì)壞死核心斑塊的機(jī)械負(fù)荷較大、可能有相對(duì)較高的破裂風(fēng)險(xiǎn)。
[Abstract]:Aim: based on the in vivo high resolution magnetic resonance imaging (HR-MRI) data of symptomatic (MCA) plaques of middle cerebral artery (MCA), a 3D fully coupled fluid-solid coupled (FSI) model was established to explore the biomechanical characteristics of MCA plaques with different components. Methods: twelve patients with symptomatic unilateral MCA with localized atherosclerotic stenosis were studied. Firstly, HR-MRI was performed on the wall of MCA before operation as the morphological basis of mechanical modeling. Secondly, the blood flow parameters and blood pressure data of the front end of MCA stenosis were collected by phase contrast MRI and DSA guided microcatheter as loading conditions. The 3D geometric structure of the target vessel is processed by mesh generation, and the finite element software ADINA (ADINA RD,Inc,USA is introduced to solve the FSI problem. Three mechanical indices were extracted from 3D FSI results: maximum principal stress (MPS), maximum principal elongation ratio (STRETCH-P1) and maximum shear stress (FMSS),. Results: according to the rate of stenosis, there was no significant difference in MPS,STRETCH-P1 and FMSS between mild and moderate stenosis group and severe stenosis group (P < 0. 932 3 ~ 0. 3872 and 0.1271). It was found that MPS in the plaques with "lipid core" was slightly higher than that in the plaques with "fibronectin" (P0. 0744), STRETCH-P1 was significantly higher than that in "fibronectin" plaques (P0. 0169), and FMSs were significantly lower than those in "fibronectin" plaques (P0. 0021). Conclusion: in symptomatic MCA atherosclerotic lesions, the principal stress and the ratio of principal elongation of "lipid core" plaques are higher than those of "fibrosis" plaques in varying degrees, suggesting that the mechanical load of plaque rich in lipid necrosis core is greater than that of "fibrosis" plaque. There may be a relatively high risk of rupture.
【作者單位】： 第二軍醫(yī)大學(xué)附屬長(zhǎng)海醫(yī)院影像醫(yī)學(xué)科;劍橋大學(xué)附屬Addenbrooke's醫(yī)院放射科;
【基金】：國(guó)家自然科學(xué)基金面上項(xiàng)目(31470910) 上海市市級(jí)醫(yī)院新興前沿技術(shù)聯(lián)合攻關(guān)項(xiàng)目(SHDC12013110) 全軍醫(yī)學(xué)科研“十二五”計(jì)劃重點(diǎn)課題(BWS12J026)
【分類(lèi)號(hào)】：R445.2;R743

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