本文選題：顱內(nèi)動(dòng)脈瘤 + 囊狀�。� 參考：《蘇州大學(xué)》2014年博士論文

【摘要】：目的 以個(gè)體特異性動(dòng)脈瘤模型為基礎(chǔ)，探索計(jì)算機(jī)數(shù)值模擬顱內(nèi)囊性動(dòng)脈瘤“虛擬壁厚”分布的方法，分析“虛擬壁厚”與動(dòng)脈瘤破裂風(fēng)險(xiǎn)之間的關(guān)系，為未破裂動(dòng)脈瘤臨床預(yù)防和治療提供理論依據(jù)。 方法 1.以動(dòng)脈瘤患者頭顱CTA掃描獲取的DICOM圖像為基礎(chǔ)，使用VMTK血管建模工具包，在Pypepad中應(yīng)用移動(dòng)立方體提取剪切感興趣區(qū)，使用水平集法等建立動(dòng)脈瘤血管段的三維表面模型。 2.使用VMTK血管建模工具包結(jié)合Python軟件，通過計(jì)算表面三維模型的Voronoi圖、計(jì)算中心線、重建中心線、切割Voronoi圖、修補(bǔ)Voronoi圖和重建等步驟，建立動(dòng)脈瘤形成前的原始載瘤血管三維模型。 3.動(dòng)脈瘤三維表面模型和重建的載瘤動(dòng)脈在Geomagic Studio中分別處理為模具和型坯，在前處理器Gambit中進(jìn)行網(wǎng)格劃分、定義邊界和計(jì)算域，使用ANSYSPOLYFLOW軟件數(shù)值模擬分析“虛擬壁厚”分布。 4.采用Geomagic Studio逆向建模軟件，通過一系列的切割、復(fù)制、縮放、變形、組合和測量等操作，達(dá)到連續(xù)修改某一幾何參數(shù)，建立多個(gè)局部幾何特征改變的系列三維表面模型。對各個(gè)系列的三維幾何變形模型分別進(jìn)行“虛擬壁厚”數(shù)值模擬計(jì)算，分析單個(gè)幾何參數(shù)和“虛擬壁厚”的之間的相關(guān)性，，初步驗(yàn)證“虛擬壁厚”的科學(xué)性。 5.對80個(gè)破裂及未破裂動(dòng)脈瘤分別進(jìn)行“虛擬壁厚”數(shù)值模擬分析，評(píng)估“虛擬壁厚”和動(dòng)脈瘤破裂風(fēng)險(xiǎn)之間的關(guān)系；并通過15名新診治動(dòng)脈瘤患者對“虛擬壁厚”參數(shù)進(jìn)行初步臨床驗(yàn)證；嘗試分析“虛擬壁厚”參數(shù)和蛛網(wǎng)膜下腔出血量（Fisher分級(jí)）的相關(guān)性。 結(jié)果 1.使用VMTK血管建模工具包能順利建立動(dòng)脈瘤三維表面模型，重建后能較好顯示動(dòng)脈瘤表面的小皰等微小幾何結(jié)構(gòu)。 2.在VMTK血管工具包和Python軟件中，通過人機(jī)互動(dòng)的方式，計(jì)算機(jī)能自動(dòng)重建去除動(dòng)脈瘤后的載瘤血管模型。 3.型坯、模具在Gambit軟件中能順利劃分網(wǎng)格、定義邊界和計(jì)算域，并可以通過Polyflow軟件進(jìn)行“虛擬壁厚”數(shù)值模擬。 4.使用逆向建模軟件的各種編輯功能，在僅改變單個(gè)幾何參數(shù)的情況下順利建立瘤高變化系列模型、瘤寬變化系列模型、瘤頸變化系列模型和體積變化系列模型�！疤摂M壁厚”和單個(gè)幾何參數(shù)的變化曲線顯示兩者具有相關(guān)性。 5.破裂組和未破裂組的最薄“虛擬壁厚”變薄倍數(shù)有統(tǒng)計(jì)學(xué)差異（P0.05），ROC曲線下面積為0.807（95％信心區(qū)間[CI]，0.711-0.904），評(píng)估破裂風(fēng)險(xiǎn)能力明顯優(yōu)于AR和SR；相對最佳臨界值為19.94倍，臨床初步驗(yàn)證有效；“虛擬壁厚”參數(shù)和蛛網(wǎng)膜下腔出血量有相關(guān)性。 結(jié)論 探索出了一種計(jì)算機(jī)數(shù)值模擬顱內(nèi)動(dòng)脈瘤“虛擬壁厚”的技術(shù)方法，“虛擬壁厚”和幾何特征參數(shù)之間，以及和動(dòng)脈瘤破裂風(fēng)險(xiǎn)之間均存在相關(guān)性，“虛擬壁厚”可以作為評(píng)估動(dòng)脈瘤破裂風(fēng)險(xiǎn)的一個(gè)參數(shù)。
[Abstract]:Purpose Based on the individual specific aneurysm model, the computer simulation method of "virtual wall thickness" distribution of intracranial cystic aneurysm was explored, and the relationship between "virtual wall thickness" and the risk of aneurysm rupture was analyzed. To provide theoretical basis for clinical prevention and treatment of unruptured aneurysms. Method 1. Based on the DICOM images obtained by CTA scan of aneurysm patients, the 3D surface model of aneurysm vascular segment was established by using the VMTK vascular modeling kit, the moving cube was used to extract the region of interest in shear in Pypepad, and the horizontal set method was used to establish the three-dimensional surface model of the aneurysm vascular segment. 2. Using VMTK vascular modeling tool kit and Python software, by calculating the Voronoi diagram of 3D surface model, calculating the center line, reconstructing the center line, cutting Voronoi diagram, repairing Voronoi diagram and reconstructing, etc. A three-dimensional model of primordial aneurysm carrying vessels was established before the formation of aneurysms. 3. The three-dimensional surface model of the aneurysm and the reconstructed aneurysm carrying artery are treated as molds and billets in Geomagic Studio respectively. The pre-processor Gambit is used to mesh the aneurysm, define the boundary and compute domain, and use ANSYSPOLYFLOW software to simulate and analyze the "virtual wall thickness" distribution. 4. Through a series of operations, such as cutting, copying, scaling, deforming, combining and measuring, Geomagic Studio reverse modeling software is used to continuously modify a certain geometric parameter and establish a series of 3D surface models with local geometric features changing. The three dimensional geometric deformation models of each series are simulated and calculated respectively, and the correlation between the single geometric parameter and the virtual wall thickness is analyzed, and the scientific nature of the virtual wall thickness is preliminarily verified. 5. The "virtual wall thickness" of 80 ruptured and unruptured aneurysms was analyzed to evaluate the relationship between the "virtual wall thickness" and the risk of aneurysm rupture. The "virtual wall thickness" parameters were preliminarily verified in 15 newly diagnosed and diagnosed aneurysms, and the correlation between the "virtual wall thickness" parameters and the subarachnoid hemorrhage volume (Fisher grade) was analyzed. Result 1. The three-dimensional surface model of the aneurysm can be successfully established by using the VMTK vascular modeling kit, and the small geometric structure such as the vesicles on the surface of the aneurysm can be well displayed after reconstruction. 2. In the VMTK vascular toolkit and Python software, the computer can automatically reconstruct the tumor carrying vessel model after the removal of aneurysm by man-machine interaction. 3. The billet and die can be meshed smoothly in Gambit software, and the boundary and calculation field can be defined, and the "virtual wall thickness" numerical simulation can be carried out by Polyflow software. 4. Using various editing functions of reverse modeling software, the series models of tumour height change, tumour width change, neck change and volume change are successfully established under the condition of changing only a single geometric parameter. The virtual wall thickness and the variation curve of a single geometric parameter show a correlation between the two. 5. The thinning times of the thinnest "virtual wall thickness" of rupture group and unruptured group were statistically different. The area under ROC curve was 0.807 ~ 95% confidence interval [CI] 0.711-0.904, the ability to assess rupture risk was obviously superior to that of AR and SRS, the relative optimum critical value was 19.94 times, and the clinical preliminary verification was effective. There was a correlation between the parameters of virtual wall thickness and the amount of subarachnoid hemorrhage. Conclusion A computer numerical simulation method for the "virtual wall thickness" of intracranial aneurysms has been developed. There is a correlation between "virtual wall thickness" and geometric characteristic parameters, as well as with the risk of aneurysm rupture. Virtual wall thickness can be used as a parameter to assess the risk of aneurysm rupture.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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