Determining the Presence of Thin-Walled Regions at High-Pressure Areas in Unruptured Cerebral Aneurysms by Using Computational Fluid Dynamics
| Autor: | Yuichi Murayama, Issei Kan, Takashi Suzuki, Kengo Nishimura, Hiroyuki Takao, Mitsuyoshi Watanabe, Satoshi Ikeuchi, Yukihiko Fujii, Makoto Yamamoto, Toshihiro Ishibashi, Yukinao Kambayashi, Shogo Kaku, Tomoaki Suzuki, Hiroki Sakamoto |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Risk medicine.medical_specialty Cerebral arteries Computational fluid dynamics 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm medicine.artery Fluid dynamics medicine Humans Cutoff business.industry Intracranial Aneurysm Middle Aged medicine.disease Confidence interval Surgery Middle cerebral artery Hydrodynamics Dynamic pressure Stress Mechanical Neurology (clinical) Nuclear medicine business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgery. 79:589-595 |
| ISSN: | 0148-396X |
| DOI: | 10.1227/neu.0000000000001232 |
| Popis: | BACKGROUND Thin-walled regions (TWRs) of cerebral aneurysms are at high risk of rupture, and careful attention should be paid during surgical procedures. Despite this, an optimal imaging technique to estimate TWRs has not been established. Previously, pressure elevation at TWRs was reported with computational fluid dynamics (CFD) but not fully evaluated. OBJECTIVE To investigate the possibility of predicting aneurysmal TWRs at high-pressure areas with CFD. METHODS Fifty unruptured middle cerebral artery aneurysms were analyzed. Spatial and temporal maximum pressure (Pmax) areas were determined with a fluid-flow formula under pulsatile blood flow conditions. Intraoperatively, TWRs of aneurysm domes were identified as reddish areas relative to the healthy normal middle cerebral arteries; 5 neurosurgeons evaluated and divided these regions according to Pmax area and TWR correspondence. Pressure difference (PD) was defined as the degree of pressure elevation on the aneurysmal wall at Pmax and was calculated by subtracting the average pressure from the Pmax and dividing by the dynamic pressure at the aneurysm inlet side for normalization. RESULTS In 41 of the 50 cases (82.0%), the Pmax areas and TWRs corresponded. PD values were significantly higher in the correspondence group than in the noncorrespondence group (P = .008). A receiver-operating characteristic curve demonstrated that PD accurately predicted TWRs at Pmax areas (area under the curve, 0.764; 95% confidence interval, 0.574-0.955; cutoff value, 0.607; sensitivity, 66.7%; specificity, 82.9%). CONCLUSION A high PD may be a key parameter for predicting TWRs in unruptured cerebral aneurysms. ABBREVIATIONS CFD, computational fluid dynamicsMCA, middle cerebral arteryPave, average pressurePD, pressure differencePmax, maximum pressureTWR, thin-walled regionWSS, wall shear stress. |
| Databáze: | OpenAIRE |
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