臺灣博碩士論文加值系統

本研究的假設是由單個滲透枝動脈閉塞引起的小洞梗塞（LI）將在基底動脈（BA）區域呈現均勻的壁面剪應力（WSS）模式；反之，可能由一個以上滲透枝動脈起源處的閉塞或狹窄引起的滲透枝動脈粥狀硬化疾病（BAD）則應呈現偏心模式。本研究的目的是使用基於患者臨床醫學影像建構之模型進行計算流體動力學（CFD）分析來研究不同血流動力學參數的影響，藉以區分LI和BAD的血流動力學特徵。本回顧性研究與台灣台南財團法人奇美醫院放射診斷科的吳德昌醫師合作。從2017年1月到2018年12月，共評估了26名患者。其中13名患者為LI，13名患者為BAD。臨床信息皆以系統性獲得。從飛行時間技術掃描磁振血管造影（time-of-flight magnetic resonance angiography, TOF-MRA）影像重建患者特異性三維幾何模型。邊界條件使用患者特異性的臨床測量數值，這些CFD模型中的入口速度是從頸動脈都普勒測量到的椎動脈（VA）的血流速度；患者的腦灌注壓（CPP）則用作出口邊界條件。除年齡外的所有危險因子和實驗室數據在兩組之間相似。BA的速度分佈與臨床數據相似。我們的總體發現是，LI組在時間平均壁面剪應力（TAWSS）值中顯示出均勻模式，其中患側與非患側顯示極為相似的結果。透過本研究對LI和BAD有稍微好一些的理解。隨著進一步的研究，未來可能可以實現更有效的診斷和治療。

The hypothesis is that lacunar infarct (LI), caused by occlusion of single perforating artery away from the orifice, would present a homogeneous pattern of wall shear stress (WSS) in the basilar artery (BA); branch atheromatous disease (BAD), caused by a focal atheromatous process with consequent occlusion of the orifices of the penetrating arteries, should present an eccentric pattern. The aim of this study was to use patient-specific image-based computational fluid dynamics (CFD) analysis method to investigate the effect of different hemodynamics parameters in order to distinguish the hemodynamic characteristics of LI and BAD. This retrospective study was cooperated with Dr. Te-Chang Wu from the Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan. From January 2017 to December 2018, a total of 26 patients were evaluated, 13 as LI and 13 had BAD. Clinical information was acquired systematically. Patient-specific three-dimensional geometry models were reconstructed from TOF-MRA images. Boundary conditions were patient-specific from medical measurements. The simulation inlet velocity at vertebral artery (VA) was measured by the carotid Doppler; cerebral perfusion pressure (CPP) was used as outlet boundary condition. All clinical data except for age were similar between groups. We found no difference in risk factors and laboratory results. Streamline distribution of BA was similar to clinical data. Our overall finding is that in the LI group a homogeneous pattern was observed in mean time-averaged wall shear stress (TAWSS), where the values of the lesion side and non-lesion side, the values of anterior and posterior component showed a consistent statistical result.

中文摘要 I
Abstract II
List of Tables V
List of Figures VI
List of Abbreviations VIII
I. Introduction: 1
1.1. Background 1
1.2. Hypothesis and purpose 4
II. Theoretical Basis and Literature Review: 5
2.1. Anatomy and physiology of brain and cerebrovascular 5
2.1.1. Brain 5
2.1.2. Circle of Willis (CoW) 5
2.1.3. Epidemiological and prevalent of stroke 7
2.1.4. Ischemic stroke and its subtypes 9
2.2. Clinical measurements 11
2.2.1. Risk factors 11
2.2.2. Magnetic resonance imaging (MRI) 12
2.2.3. Carotid Doppler ultrasound 13
2.3. Computational Fluid Dynamics (CFD) 15
2.3.1. Blood flow simulation 15
2.3.2. Commercial CFD software 15
III. Materials and Methods: 16
3.1. Overall procedures 16
3.2. Subjects and image protocols 18
3.2.1. Patients 18
3.2.2. Clinical workup 20
3.2.3. Image protocols 20
3.3. Model geometry 22
3.3.1. Image and model acquisition 22
3.3.2. Flow extension tube 24
3.3.3. Mesh 26
3.4. Boundary conditions 28
3.4.1. Inlets and outlets 28
3.4.2. Profile 30
3.4.3. Vessel wall and blood properties 30
3.5. Statistics 31
IV. Results: 32
4.1. Clinical data statistics 32
4.2. Streamline distribution 36
4.3. TAWSS distribution 38
V. Discussion: 56
VI. Conclusion: 62
References: 63

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