颅内动脉瘤破裂的血流动力学-形态学鉴别特征。
Hemodynamic-morphologic discriminants for intracranial aneurysm rupture.
机构信息
Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, NY 14214, USA.
出版信息
Stroke. 2011 Jan;42(1):144-52. doi: 10.1161/STROKEAHA.110.592923. Epub 2010 Nov 24.
BACKGROUND AND PURPOSE
the purpose of this study was to identify significant morphological and hemodynamic parameters that discriminate intracranial aneurysm rupture status using 3-dimensional angiography and computational fluid dynamics.
METHODS
one hundred nineteen intracranial aneurysms (38 ruptured, 81 unruptured) were analyzed from 3-dimensional angiographic images and computational fluid dynamics. Six morphological and 7 hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic analysis identified area under the curve (AUC) and optimal thresholds separating ruptured from unruptured aneurysms for each parameter. Significant parameters were examined by multivariate logistic regression analysis in 3 predictive models-morphology only, hemodynamics only, and combined-to identify independent discriminants, and the AUC receiver operating characteristic of the predicted probability of rupture status was compared among these models.
RESULTS
morphological parameters (size ratio, undulation index, ellipticity index, and nonsphericity index) and hemodynamic parameters (average wall shear stress [WSS], maximum intra-aneurysmal WSS, low WSS area, average oscillatory shear index, number of vortices, and relative resident time) achieved statistical significance (P<0.01). Multivariate logistic regression analysis demonstrated size ratio to be the only independently significant factor in the morphology model (AUC, 0.83; 95% CI, 0.75 to 0.91), whereas WSS and oscillatory shear index were the only independently significant variables in the hemodynamics model (AUC, 0.85; 95% CI, 0.78 to 0.93). The combined model retained all 3 variables, size ratio, WSS, and oscillatory shear index (AUC, 0.89; 95% CI, 0.82 to 0.96).
CONCLUSIONS
all 3 models-morphological (based on size ratio), hemodynamic (based on WSS and oscillatory shear index), and combined-discriminate intracranial aneurysm rupture status with high AUC values. Hemodynamics is as important as morphology in discriminating aneurysm rupture status.
背景与目的
本研究旨在利用三维血管造影和计算流体动力学确定区分颅内动脉瘤破裂状态的显著形态和血流动力学参数。
方法
从三维血管造影图像和计算流体动力学中分析了 119 个颅内动脉瘤（38 个破裂，81 个未破裂）。评估了 6 个形态学和 7 个血流动力学参数，以确定与破裂相关的显著性。接收者操作特征分析确定了每个参数区分破裂和未破裂动脉瘤的曲线下面积（AUC）和最佳阈值。多元逻辑回归分析用于 3 种预测模型（形态学仅、血流动力学仅和联合）中，以确定独立的判别因素，并比较这些模型中预测破裂状态概率的 AUC 接收者操作特征。
结果
形态学参数（大小比、波动指数、椭圆度指数和非球形指数）和血流动力学参数（平均壁切应力[WSS]、最大瘤内 WSS、低 WSS 区域、平均振荡剪切指数、涡数量和相对驻留时间）达到统计学意义（P<0.01）。多元逻辑回归分析表明，大小比是形态学模型中唯一独立显著的因素（AUC，0.83；95%CI，0.75 至 0.91），而 WSS 和振荡剪切指数是血流动力学模型中唯一独立显著的变量（AUC，0.85；95%CI，0.78 至 0.93）。联合模型保留了所有 3 个变量，大小比、WSS 和振荡剪切指数（AUC，0.89；95%CI，0.82 至 0.96）。
结论
所有 3 种模型——形态学（基于大小比）、血流动力学（基于 WSS 和振荡剪切指数）和联合模型——均以高 AUC 值区分颅内动脉瘤破裂状态。血流动力学与形态学一样，在区分动脉瘤破裂状态方面具有重要意义。
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