1Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
2Department of Neurosurgery, Mie Chuo Medical Center, National Hospital Organization, Tsu, Mie, Japan.
J Neurosurg. 2023 Jun 30;140(1):138-143. doi: 10.3171/2023.5.JNS222752. Print 2024 Jan 1.
Larger cerebral aneurysms are more likely to enlarge, but even small aneurysms can grow. The aim of this study was to investigate the hemodynamic characteristics regarding the growth of small aneurysms using computational fluid dynamics (CFD).
The authors analyzed 185 patients with 215 unruptured cerebral aneurysms with a maximum diameter of 3-5 mm, registered in a multicenter prospective observational study of unruptured aneurysms (Systematic Multicenter Study of Unruptured Cerebral Aneurysms Based on Rheological Technique at Mie) from January 2013 to February 2022. Based on findings on repeated images, aneurysms were divided into a stable group (182 aneurysms) and a growth group (33 aneurysms). The authors developed the high shear concentration ratio (HSCR), in which high wall shear stress (HWSS) was defined as a value of 110% of the time-averaged wall shear stress of the dome. High shear area (HSA) was defined as the area with values above HWSS, and the ratio of the HSA to the surface area of the dome was defined as the HSA ratio (HSAR). They also created the flow concentration ratio (FCR) to measure the concentration of the inflow jet. Multivariate logistic regression analysis was performed to determine morphological variables and hemodynamic parameters that independently characterized the risk of growth.
The growth group had a significantly higher projection ratio (0.74 vs 0.67, p = 0.04) and volume-to-ostium area ratio (1.72 vs 1.44, p = 0.02). Regarding the hemodynamic parameters, the growth group had significantly higher HSCR (6.39 vs 4.98, p < 0.001), lower HSAR (0.28 vs 0.33, p < 0.001), and lower FCR (0.61 vs 0.67, p = 0.005). In multivariate analyses, higher HSCR was significantly associated with growth (OR 0.81, 95% CI 7.06 e-1 to 9.36 e-1; p = 0.004).
HSCR may be a useful hemodynamic parameter to predict the growth of small unruptured cerebral aneurysms.
较大的脑动脉瘤更有可能增大，但即使是小动脉瘤也可能生长。本研究旨在使用计算流体动力学（CFD）研究与小动脉瘤生长相关的血流动力学特征。
作者分析了 2013 年 1 月至 2022 年 2 月在一项基于流变技术的多中心未破裂颅内动脉瘤系统观测研究（三重县基于流变技术的多中心未破裂颅内动脉瘤系统观测研究）中登记的 185 例最大直径为 3-5 毫米的 215 例未破裂脑动脉瘤患者。根据重复图像的结果，将动脉瘤分为稳定组（182 个动脉瘤）和生长组（33 个动脉瘤）。作者提出了高剪切浓度比（HSCR），其中高壁剪切应力（HWSS）定义为穹顶时均壁剪切应力的 110%。高剪切面积（HSA）定义为值高于 HWSS 的区域，并且将 HSA 与穹顶表面积的比值定义为 HSA 比（HSAR）。他们还创建了流量浓度比（FCR）来测量流入射流的浓度。采用多变量逻辑回归分析确定独立特征生长风险的形态学变量和血流动力学参数。
生长组的投影比（0.74 对 0.67，p = 0.04）和容积-口面积比（1.72 对 1.44，p = 0.02）显著更高。在血流动力学参数方面，生长组的 HSCR 显著更高（6.39 对 4.98，p <0.001），HSAR 更低（0.28 对 0.33，p <0.001），FCR 更低（0.61 对 0.67，p = 0.005）。在多变量分析中，较高的 HSCR 与生长显著相关（OR 0.81，95%CI 7.06e-1 至 9.36e-1；p = 0.004）。
HSCR 可能是预测小未破裂脑动脉瘤生长的有用血流动力学参数。
