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研究生： 李明龍
Li, Ming-Lung
論文名稱： 大腦動脈瘤內血液動力學分析
Hemodynamics Analysis in Intracranial Aneurysm
指導教授： 林昭安
Lin, Chao-An
劉通敏
Liou, Tong-Miin
口試委員: 牛仰堯
Niu, Yang-Yao
吳宗信
Wu, Chong-shin
陳慶耀
Chen, Chin-Yao
陳明志
Chern, Ming-Jyh
廖川傑
Liao, Chuan-Chieh
學位類別： 博士
Doctor
系所名稱： 工學院 - 動力機械工程學系
Department of Power Mechanical Engineering
論文出版年： 2019
畢業學年度： 107
語文別： 英文
論文頁數： 131
中文關鍵詞： 動脈瘤 、風險 、計算流體力學 、血液動力學分析 、拓樸學
外文關鍵詞： aneurysm, risk, CFD, hemodynamic, tomography
相關次數： 點閱：2  下載：0 
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    • 血流動力學對於腦動脈瘤的形成、生長和破裂的成因是重要的課題。並對患者動脈瘤模型執行數值分析，對增強我們對腦動脈瘤的流動相關病理生理學知識的有很大的幫助。本研究採用多孔材料模擬線圈栓塞，結果顯示，當填充率在35％和45％之間時，平均剪切應力減少了37.5％至57.2％。並且，使用計算流體動力學來分析壁面剪切應力分佈，評估血液動力學因素及形態參數對於動脈瘤破裂的相關性。在形態學上，破裂組和未破裂組之間的四個變量（縱橫比，橢圓度指數，非球形指數和波動指數）顯著不同。在動脈瘤表面上的低壁剪切面積的百分比在破裂和未破裂的動脈瘤組之間也是顯著的（分別為46.5％對29.8％，P = 0.01）。此外，對於長寬比> 1.4或非球形度指數> 0.16的動脈瘤，結合低壁切應力比> 39％，破裂病例的百分比分別為88.2％和84.2％。
    除此之外，本研究也發現，在拍攝斷層掃描血管造影的同時，腦動脈瘤正在破裂的案例，並獲取破裂區域的精確位置。研究分析表示破裂區域的平均和時間平均WSSes低於動脈瘤表面上的WSS。本研究顯示低WSS區域與動脈瘤破裂區域之間存在相關性。這可能有助於預測動脈瘤可能破裂的位置，從而與治療決策過程相關。

    Hemodynamics is important in the formation, growth and rupture of the cerebral aneurysm. Numerical analysis of patient-specific aneurysm models has great potential for enhancing our knowledge of the flow-related pathophysiology of cerebral aneurysms. A porous material was used to represent the coil embolization. The results show the average shear stress is reduced by 37.5% to 57.2% in case of the filling ratio being between 35% and 45%.The ruptured aneurysm study has shown a correlation between regions of low WSS and regions of aneurysm rupture.
    We then used computational fluid dynamics to determine the wall shear stress distribution, evaluated the hemodynamic factors, and analyzed aneurysm geometries for a range of morphological parameters. Morphologically, four variables (aspect ratio, ellipticity index, non-sphericity index, and undulation index) were significantly different between the ruptured and unruptured groups. Hemodynamically, the percentage of the low wall shear area over the entire aneurysmal surface was also significant between the ruptured and unruptured aneurysm groups (46.5% versus 29.8%, respectively, P=0.01). Furthermore, for the aneurysms with either aspect ratio >1.4 or non-sphericity index > 0.16 in conjunction with ratio of low wall shear stress >39%, the percentages of ruptured cases were 88.2% and 84.2%, respectively. Among the 7morphologic and 6 hemodynamic parameters investigated, the aspect ratio, ellipticity index, non-sphericity index, undulation index area , and wall shear stress were significant.
    Precise locations of rupture region under contrast agent leakage of five ruptured cerebral artery aneurysms during computed tomography angiography. The mean and time averaged WSSes at rupture regions are found to be lower than those over the surface of the aneurysms. The present study has shown a correlation between regions of low WSS and regions of aneurysm rupture. This could be helpful in predicting where an aneurysm might rupture, and thus be of relevance to the therapeutic decision-making process.

    Abstract IV Contents XI 1 Introduction 1 1.1 Background and Significance 1 1.2 Reference Reviewed 3 1.3 Purpose and Contribution of Research 8 1.3.1 Flow Analysis in Coil Embolization Models 9 1.3.2 The Influence of Intracranial Aneurysm Morphology and Hemodynamics on Rupture Risk 10 1.3.3 Flow analysis in ruptured cerebral aneurysm 10 2 Materials Model and Numerical Methods 13 2.1 Reconstruction Model from CTA 14 2.2 Governing Equation 15 2.3 Numerical Simulation 19 2.4 Morphological Parameters Calculation 20 2.5 Hemodynamic Parameter Calculation 22 2.6 Boundary Condition 23 3 Flow Analysis in Coil Embolization Models 31 3.1 Simulated Model by Coil Embolization 32 3.1.1 Physics Model 32 3.1.2 Reference Criterion of Blood Clotting 33 3.1.3 Phenomenon of the Streamline 34 3.1.4 Analysis of Shear Strain Rate 35 3.2 Clinical Patient-Specific Model by Coil Embolization 37 3.2.1 Purpos of Clinical Patients model Analysis 37 3.2.2 Variation of the Inlet Velocity 38 3.2.3 Flow Analysis of Clinical Patients Model 39 3.2.4 WSS Analysis of Clinical Patients Model 41 4 The Influence of Intracranial Aneurysm Morphology and Hemodynamics on Rupture Risk 54 4.1 Subject and motivation 56 4.2 Statistical Analysis 57 4.2.1 Univariate Analysis of Differences between the Ruptured and Unruptured Groups 57 4.2.2Multivariate Logistic Regression on the Significant Variables 58 4.3 Statistical Results 60 4.3.1 WSS Characterization 60 4.3.2 Differences between Ruptured and Unruptured Groups from the Calculated Hemodynamic Parameters 61 4.3.3 Differences between Ruptured and Unruptured Groups from the Calculation of Morphological Parameters 62 4.3.4 Multivariate Logistic Regression on the Significant Variables 65 4.4 Discussion 65 4.4.1 Hemodynamic Measures 66 4.4.2 Morphological Measures 67 4.4.3 The Relationship between Morphological and Hemodynamic Parameters 71 5 Flow Analysis in Ruptured Cerebral Aneurysm 80 5.1 Subject and motivation 81 5.2 Image reconstruction and processing 84 5.3 Rupture points 85 5.4 Numerical model and grids of CFD 86 5.5 Results and Discussion of the Hemodynamics on Intracranial Aneurysm Ruptured Region 88 6 Preliminary Conclusion and Future Work 100 6.1 Preliminary Conclusion 100 6.2 Recommendations for Future Work 104 Bibliography 107 Appendix A 120

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