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根据4DMRI提取的脉冲波的患者特定合规模拟框架速度:TEVAR后的应用.
Louis Girardin1, Niklas Lind2, Hendrik von Tengg-Kobligk2
1University College London, Department of Mechanical Engineering, Torrington Place, London WC1E7JE, UK; Welcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), 43-45 Foley Street, London W1W7TS, UK.
Journal of biomechanics
|September 4, 2024
概括
这项研究引入了使用4D流MRI的脉冲波速度 (PWV) 的新计算框架,以改善TEVAR后B型大动脉剖析 (TBAD) 的患者特定模拟. 与基于区域的方法相比,基于RPWV的模拟更准确地预测血液动力学和识别血栓形成风险.
科学领域:
- 生物医学工程 生物医学工程
- 心血管成像 - 心血管成像
- 计算流体动力学的流体动力学.
背景情况:
- 乙型大动脉剖析 (TBAD) 具有重大风险,通常用胸内血管大动脉修复 (TEVAR) 进行治疗.
- 准确的患者特定计算流体动力学 (CFD) 模拟对于评估TEVAR后血液动力学和预测并发症至关重要.
- 当前的模拟方法可能无法完全捕捉切割的大动脉的复杂生物力学.
研究的目的:
- 开发和验证一个新的计算框架,将4D流MRI衍生的脉冲波速度 (PWV) 集成到TEVAR后B型大动脉剖析的患者特定的CFD模拟中.
- 为了比较基于区域PWV (RPWV) 的延伸度与基于区域的延伸度的准确性,以模拟大动脉壁机制.
- 评估不同度估计方法对血液动力学预测的影响,包括壁剪应力 (WSS) 和血栓形成风险.
主要方法:
- 使用4D流MRI (4DMRI) 数据开发了一个计算框架,以提取PWV并定义患者特定的胸前大动脉几何形状,3D输入速度配置 (IVP) 和动态输出边界条件.
- 使用移动边界方法 (MBM) 来模拟大动脉壁的移位.
- 使用两种方法估计了大动脉壁硬度:基于面积的延伸度和基于RPWV的延伸度,并微调以匹配体内数据.
- 对B型大动脉剖析 (TBAD) 患者进行了CFD模拟,后进行胸腔内血管大动脉修复 (TEVAR).
主要成果:
- 预测的压力和出口流量与目标值 (在2.3%以内) 非常接近.
- 基于RPWV的模拟显示,与基于区域的模拟相比,在复制体内血液动力学方面具有更高的准确性.
- 系统性流量逆转比率 (SFRR) 被准确地捕获;然而,在平面内旋转流量 (IRF) 中观察到显著差异 (高达60%).
- 在预测壁切应力 (WSS) 基础上的指数,特别是内皮细胞激活潜力 (ECAP) 中,两种方法之间注意到了差异.
- 在RPWV驱动的模拟确定高ECAP (>1.4Pa-1) 在地峡,表明潜在的血栓形成风险,并没有预测的基于面积的方法.
结论:
- 拟议的管道,利用4DMRI的RPWV进行CFD模拟,为评估TEVAR TBAD后提供了一种经过验证和全面的方法.
- 基于RPWV的延展性是估计大动脉壁硬度和预测体内血液动力学的更准确方法,而不是基于区域的延展性.
- 这种先进的模拟框架有助于更好的手术决策,并有助于预测潜在的并发症,如血栓形成和大动脉生长.
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