Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ 86011.
Department of Radiology, Saint Louis University, St Louis, MO 63110.
J Biomech Eng. 2022 Nov 1;144(11). doi: 10.1115/1.4054515.
Benign prostatic hyperplasia (BPH) is a common disease associated with lower urinary tract symptoms and is the most frequent benign tumor in men. To reduce BPH therapy complications, prostatic artery embolization (PAE) was developed to replace the surgical options. PAE is a minimally invasive technique in which emboli are injected into the prostate arteries (PA), obstructing the blood flow in the hypervascular nodules. In this work, a personalized PAE treatment strategy was proposed using patient-specific computational fluid dynamics (CFD). First, the hemodynamics environment in the iliac arterial tree considering a large network of bifurcations was studied. The results showed complex blood flow patterns in the iliac arterial network. Subsequently, the transport of embolic particulates during PAE for the standard horizontal and hypothetical vertical patient positioning was simulated using Lagrangian particle tracking. Emboli of different sizes were released at various locations across the iliac arterial tree. The emboli entering the PA were mapped back to their initial location to create emboli release maps (ERMs). The obtained ERMs during the standard patient positioning for smaller emboli at certain release locations showed distinct regions in which if the emboli were released within these regions, all of them would reach the PA without nontarget embolization. During the hypothetical vertical patient positioning, the larger emboli formed a larger coherent region in the ERMs. Our patient-specific model can be used to find the best spatial location for emboli injection and perform the embolization procedure with minimal off-target delivery.
良性前列腺增生症（BPH）是一种与下尿路症状相关的常见疾病，是男性最常见的良性肿瘤。为了减少 BPH 治疗的并发症，前列腺动脉栓塞术（PAE）被开发出来以替代手术选择。PAE 是一种微创技术，将栓塞剂注入前列腺动脉（PA），阻塞富含血管的结节中的血流。在这项工作中，使用患者特异性计算流体动力学（CFD）提出了一种个性化的 PAE 治疗策略。首先，研究了考虑大的分叉网络的髂动脉树中的血液动力学环境。结果表明，髂动脉网络中的血流模式复杂。随后，使用拉格朗日粒子跟踪模拟了 PAE 期间栓塞颗粒在标准水平和假设垂直患者定位下的传输。不同大小的栓塞物在髂动脉树的不同位置释放。将进入 PA 的栓塞物映射回其初始位置，以创建栓塞物释放图（ERM）。在标准患者定位下，对于某些释放位置的较小栓塞物，获得的 ERM 显示出明显的区域，如果在这些区域内释放栓塞物，所有栓塞物都将到达 PA 而不会发生非靶向栓塞。在假设的垂直患者定位下，较大的栓塞物在 ERM 中形成了一个更大的连贯区域。我们的患者特异性模型可用于找到栓塞物注射的最佳空间位置，并以最小的脱靶递送进行栓塞治疗。
