脑Willis环的一维血流动力学及氧输运特性的数值研究

Willis环是大脑侧枝循环的重要组成部分, 研究其血流动力学特性以及氧输运规律对脑缺血疾病的认知和预防有着非常重要的作用. 该文旨在利用一维血流动力学模型模拟整个Willis环的流量变化和压力分布, 并建立动脉内氧输运的一维模型以模拟Willis 环内氧分压的变化规律, 为研究脑组织内血液流动和氧输运打下基础. 首先, 基于弹性圆管内的一维非线性流动方程和状态方程建立血流动力学模型, 在一维对流扩散方程的基础上, 考虑由管腔向壁面的扩散和壁面细胞的新陈代谢消耗推导出氧输运特性方程. 通过 Lax-Wendroff两步法对血流动力学方程进行离散, 而在进行对流扩散方程的离散时, 则运用迎风格式. 通过数值计算得到了正常情况下Willis环各个血管任意位置的流量、压力和氧分压的变化曲线, 正常情况下各个位置的氧分压处于稳定的平衡状态. 最后, 还通过此模型进一步模拟了右侧颈内动脉狭窄对各个血管内流动的影响. 当狭窄程度达到80%时, 中脑动脉的流量和压力会明显下降, 造成其供应区域的血流减少. 同时, Willis环右侧血管内的氧分压会大大降低, 而左侧血管的氧分压会出现上升趋势, 但幅度要小于右侧血管降低的幅度.     

Evaluation of aortic stenosis severity using 4D flow jet shear layer detection for the measurement of valve effective orifice area

Aims

The objective of this study was to evaluate the potential of 4D flow MRI to assess valve effective orifice area (EOA) in patients with aortic stenosis as determined by the jet shear layer detection (JSLD) method.

Methods and Results

An in-vitro stenosis phantom was used for validation and in-vivo imaging was performed in 10 healthy controls and 40 patients with aortic stenosis. EOA was calculated by the JSLD method using standard 2D phase contrast MRI (PC-MRI) and 4D flow MRI measurements (EOA_JSLD-2D and EOA_JSLD-4D, respectively). As a reference standard, the continuity equation was used to calculate EOA (EOA_CE) with the 2D PC-MRI velocity field and compared to the EOA_JSLD measurements. The in-vitro results exhibited excellent agreement between flow theory (EOA = 0.78 cm²) and experimental measurement (EOA_JSLD-4D = 0.78 ± 0.01 cm²) for peak velocities ranging from 0.9 to 3.7 m/s. In-vivo results showed good correlation and agreement between EOA_JSLD-2D and EOA_CE (r = 0.91, p < 0.001; bias: − 0.01 ± 0.38 cm²; agreement limits: 0.75 to − 0.77 cm²), and between EOA_JSLD-4D and EOA_CE (r = 0.95, p < 0.001; bias: − 0.09 ± 0.26 cm²; limits: 0.43 to − 0.62 cm²).

Conclusion

This study demonstrates the feasibility of measuring EOA_JSLD using 4D flow MRI. The technique allows for optimization of the EOA measurement position by visualizing the 3D vena contracta, and avoids potential sources of EOA_CE measurement variability.     

Pediatric Laryngotracheal Stenosis and Airway Reconstruction: A Review of Voice Outcomes, Assessment, and Treatment Issues

Laryngotracheal stenosis is defined as a congenital or acquired narrowing of the airway. Congenital causes may include subglottic membranous or cartilaginous narrowing. Acquired causes may include trauma due to prolonged endotracheal or tracheal intubation or laryngotracheal injury. Although advances have been made over the past 30 years in reconstructive surgeries to improve airway patency in these patients, long-term laryngeal function for voice production is not well defined in this population. This review examines causes, symptoms and signs, and methods for diagnosing laryngotracheal stenosis. Surgical management procedures are briefly summarized. The current literature on voice outcomes is summarized. The predominant voice characteristics in the population are presented, although results are challenged by the heterogeneity of voice presentation and paucity of data from instrumental measures. Considerations for subjective and instrumental assessment, measures of quality of life, instrumental methods, and treatment options specific to the needs of this population are discussed. Research strategies to identify long-term outcomes of surgical and behavioral treatments in this population are posed.     

Significance of plaque morphology in modifying flow characteristics in a diseased coronary artery: Numerical simulation using plaque measurements from intravascular ultrasound imaging

The paper deals with numerical investigation of the effect of plaque morphology on the flow characteristics in a diseased coronary artery using realistic plaque morphology. The morphological information of the lumen and the plaque is obtained from intravascular ultrasound imaging measurements of 42 patients performed at Cleveland Clinic Foundation, Ohio. For this data, study of Bhaganagar et al. (2010) [1] has revealed the stenosis for 42 patients can be categorized into four types – type I (peak-valley), type II (ascending), type III (descending), and type IV (diffuse). The aim of the present study is to isolate the effect of shape of the stenosis on the flow characteristics for a given degree of the stenosis. In this study, we conduct fluid dynamic simulations for the four stenosis types (type I–IV) and analyze the differences in the flow characteristics between these types. Finely refined tetrahedral mesh for the 3-D solid model of the artery with plaques has been generated. The 3-D steady flow simulations were performed using the turbulence (k–ε) model in a finite volume based computational fluid dynamics solver. The axial velocity, the radial velocity, turbulence kinetic energy and wall shear stress profiles of the plaque have been analyzed. From the axial and radial velocity profiles results the differences in the velocity patterns are significantly visible at proximal as well as distal to the throat, region of maximum stenosis. Turbulent kinetic energy and wall shear stress profiles have revealed significant differences in the vicinity of the plaque. Additional unsteady flow simulations have been performed to validate the hypothesis of the significance of plaque morphology in flow alterations in diseased coronary artery. The results revealed the importance of accounting for plaque morphology in addition to plaque height to accurately characterize the turbulent flow in a diseased coronary artery.     

Dynamic response of pulsatile flow of blood in a stenosed tapered artery

The aim of this paper is to throw some light on the rheological study of pulsatile blood flow in a stenosed tapered arterial segment. Arterial wall is considered to be rigid and flexible separately for improving the similarity to the in vivo situation. The streaming blood is considered to be Newtonian. The governing nonlinear equations of motion are sought using the well‐known stream function‐vorticity method and are solved numerically by finite difference technique. Important rheological parameters, such as axial velocity component, wall shear stress, and flow separation region are estimated in the neighborhood of the stenosis. Effects of stenosis height, vessel tapering, and wall flexibility on the blood flow are investigated properly and are explained in detail through their graphical representations.     

CT联合血清HCY、β2-M在下肢动脉狭窄闭塞性疾病中的诊断价值

本文对CT联合血清同型半胱氨酸（HCY）、β2-微球蛋白（β2-M）在下肢动脉狭窄闭塞性疾病中的诊断价值进行分析。选取上海市金山区中西医结合医院收治的120例疑似下肢动脉狭窄闭塞性疾病患者进行研究，选取同期健康体检者120例作为对照组，对患者进行CT检查、血清HCY和β2-M水平检查，并比较了CT诊断下肢动脉狭窄闭塞情况、两组患者血清HCY和β2-M水平，以明确CT、HCY、β2-M诊断价值及误诊率、漏诊率。结果显示，120例疑似患者中，CT检测出646节段病变血管，其中轻度狭窄155节段，中度狭窄257节段，重度狭窄143节段，血管完全闭塞91节段；研究组患者血清HCY、β2-M水平明显高于对照组，两组比较差异有统计学意义（P<0.05）；HCY的AUC为0.863，截断值>21.75（μmol/L），诊断敏感性为79.00%，特异性为80.00%，β2-M的AUC为0.837，截断值>2.98（μmol/mL），诊断敏感性为75.25%，特异性为65.21%；CT诊断阳性率为67.50%，HCY诊断阳性率为69.17%，β2-M诊断阳性率为67.50%，三者联合诊断阳性率为82.50%，联合诊断阳性率高于CT、HCY、β2-M单独诊断阳性率（P<0.05）；CT、HCY、β2-M单一检测对下肢动脉狭窄闭塞性疾病均有较高灵敏度、特异性及准确度，但三者联合诊断灵敏度、特异性及准确度最高，误诊率、漏诊率最低。本文证实了采用CT联合血清HCY、β2-M诊断下肢动脉狭窄闭塞性疾病诊断灵敏度、特异性及准确度高，误诊率、漏诊率低。     

Assessment of clinical data of nonlinear stochastic deconvolution versus block-circulant singular value decomposition for quantitative dynamic susceptibility contrast magnetic resonance imaging

Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) allows the noninvasive assessment of brain hemodynamics alterations by quantifying, via deconvolution, the cerebral blood flow (CBF) and mean transit time (MTT). Singular value decomposition (SVD) and block-circulant SVD (cSVD) are the most widely adopted deconvolution method, although they bear some limitations, including unphysiological oscillations in the residue function and bias in the presence of delay and dispersion between the tissue and the arterial input function. A nonlinear stochastic regularization (NSR) has been proposed, which performs better than SVD and cSVD on simulated data both in the presence and absence of dispersion. Moreover, NSR allows to quantify the dispersion level. Here, cSVD and NSR are compared for the first time on a group of nine patients with severe atherosclerotic unilateral stenosis of internal carotid artery before and after carotid stenting to investigate the effect of arterial dispersion. According to region of interest-based analysis, NSR characterizes the pathologic tissue more accurately than cSVD, thus improving the quality of the information provided to physicians for diagnosis. In fact, in 7 (78%) of the 9 subjects, CBF and MTT maps provided by NSR allow to correctly identify the pathologic hemisphere to the physician. Moreover, by emphasizing the difference between pathologic and healthy tissues, NSR may be successfully used to monitor the subject's recovery after the treatment and/or surgery. NSR also generates dispersion level and non-dispersed CBF and MTT maps. The dispersion level provides information on CBF and MTT estimates reliability and may also be used as a clinical indicator of pathological tissue state complementary to CBF and MTT, thus increasing the clinical information provided by DSC-MRI analysis.     

双向流固耦合作用下狭窄左冠状动脉内两相血流分析

基于血流与血管壁间双向流固耦合作用,将血液设为两相流体,运用计算流体力学方法对左冠状动脉内血流进行瞬态数值模拟.研究了一个心动周期内典型时刻下左冠状动脉内血流分布特性,并与Newton(牛顿)血液和两相血液模型对比,分析了两相血液和流固耦合作用对血流特性的影响.结果表明,左冠状动脉左回旋支远段和钝缘支近心端外侧分布了低速涡流区,该区域内壁面切应力和红细胞体积分数均较小,为动脉粥样硬化的形成与发展提供了合适的生理环境.左冠状动脉分叉处管壁形变量较大,引起管壁内膜功能发生紊乱,促进了粥样硬化斑块的形成.3种血液模型对比可知,红细胞的流动特性对血流速度及壁面切应力等血流动力学特性影响较大,双向流固耦合模型更符合真实的血液流动情况.     

浅谈动脉流体动力学分析

就我们所熟知,绝大部分正常动脉流,其血液的流动特性是属于层流范围,但随着弯曲和分 支部分会产生血液流之二次回流区,进而形成所谓近似非稳态流及紊流. 因此动脉流体的特 性会随动脉外形及条件的改变而改变. 在某些情形下,异常动脉的血液动力特性会造成动脉 的病变. 因此,近年来动脉血液流体的特性的研究,常着重于异常动脉的血液动力特性所形 成剪应力和病变部位动脉粥状硬化关系的探讨. 动脉血液流动经常包含分离流或二次回流运动,而这是流体力学的分析或数值模拟最困难的 部分. 有关分离流或二次回流的研究包括正常血管流和异常血管流,藉由二次回流的模拟与 测量可以观察血管病变的形成与演变,其中最受注目探讨题目是窄化血管如粥状斑块相关的 血液流动分析. 将回顾二维和三维、稳态、非稳态之动脉血流与窄化血管相关的几何外形作模拟研究和 实验. 并提供对血液动力学的研究方向,以作为未来医疗诊断与发展相关器材之参考.     

Relationship between the hemodynamic changes on multi-Td pulsed arterial spin labeling images and the degrees of cerebral artery stenosis

Objective

To explore the relationship between the hemodynamic changes on multi-Td (delay time) pulsed arterial spin labeling (PASL) images and the degrees of cerebral artery stenosis, and to evaluate the value of multi-Td PASL in detecting the signal changes in cerebral arteries with stenosis.

Patients and methods

29 patients with less than 50% stenosis (mild stenosis group) and 22 patients with 50%–69% stenosis (moderate stenosis group) in M1 segment of unilateral middle cerebral artery (MCA) were included in this study. The degrees of MCA stenosis were measured using time of flight MR angiography (TOF MRA). Multi-Td PASL imaging was performed to detect the signal changes in bilateral MCA. We selected and hand-drew bilateral symmetric branches of MCA as regions of interest (ROIs) on eight-Td PASL images. The intensities of ROIs were measured, and the time-signal intensity curves were acquired by post-processing on a MR workstation. SPSS19.0 statistical software was used for statistics. The differences in the peak intensities and the times to peak intensities between the normal and narrowed sides of the mild and moderate stenosis groups were respectively examined by paired-samples t test. The differences in the changes of peak intensities and times to peak intensity of the two sides between the mild and moderate stenosis groups were examined by independent samples t test. A p value less than 0.05 was considered statistically significant.

Result

There were significant difference in the peak intensities (t = − 2.720, p = 0.011 < 0.05) and no significant difference in the times to peak intensities (t = − 1.279, p = 0.212 > 0.05) between the normal and narrowed sides of the mild stenosis group. There were both significant differences in the peak intensities (t = − 6.076, p = 0.000 < 0.05) and times to peak intensities (t = 7.232, p = 0.000 < 0.05) between the normal side and narrowed side of the moderate stenosis group. There were both significant differences in the changes of peak intensities (t = − 2.11, p = 0.040 < 0.05) and times to peak intensity (t = − 4.23, p = 0.000 < 0.05) between the mild and moderate stenosis groups.

Conclusion

The hemodynamic changes on multi-Td PASL images were different with the degrees of cerebral artery stenosis. Moderate stenosis means greater hemodynamic changes in the arteries than mild stenosis. Multi-Td PASL imaging is a promising means to evaluate the hemodynamic changes in cerebral arteries with stenosis.