【摘要】：目的:以癥狀性大腦中動脈(MCA)斑塊的活體高分辨率磁共振成像(HR-MRI)數據為基礎,建立3D完全耦合的流-固耦合(FSI)模型,探索不同組分MCA斑塊的生物力學特征。方法:研究對象為擬行介入手術治療的12例癥狀性單側MCA局限性動脈粥樣硬化狹窄的患者。首先,術前對MCA管壁行HR-MRI作為力學建模的形態(tài)學依據;其次,利用相位對比MRI技術和DSA引導下的測壓微導管分別采集MCA狹窄前端的血流參數和血壓數據作為載荷條件,并對目標血管的3D幾何結構進行網格生成等前處理,導入有限元程序軟件ADINA(ADINA RD,Inc,USA)進行FSI求解;最后,從3D FSI結果中提取3個力學指標值:最大主應力(MPS)、最大主伸長比(STRETCH-P1)和最大剪應力(FMSS),分析比較不同狹窄程度和不同斑塊成分的各項力學指標的差異。結果:按照狹窄率分組比較發(fā)現,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統(tǒng)計學意義(P=0.9323、0.3872和0.1271)。分析不同斑塊成分發(fā)現,含"脂質核心"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)。結論:癥狀性MCA粥樣硬化病變中,"脂質核心"斑塊的主應力和主伸長比均不同程度地高于"纖維化"斑塊,提示富含脂質壞死核心斑塊的機械負荷較大、可能有相對較高的破裂風險。
[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)大學附屬長海醫(yī)院影像醫(yī)學科;劍橋大學附屬Addenbrooke's醫(yī)院放射科;
【基金】：國家自然科學基金面上項目(31470910) 上海市市級醫(yī)院新興前沿技術聯合攻關項目(SHDC12013110) 全軍醫(yī)學科研“十二五”計劃重點課題(BWS12J026)
【分類號】：R445.2;R743

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