项目名称： 颅内夹层动脉瘤动态变化的影像学基础和血流动力学机制研究

项目编号： No.81471167

项目类型： 面上项目

立项/批准年度： 2015

项目学科： 医药、卫生

项目作者： 汪阳

作者单位： 南昌大学

项目金额： 70万元

中文摘要： 颅内夹层动脉瘤是难治性脑血管病，其病理过程与颅内囊状动脉瘤不同,呈动态变化。尸检发现管壁结构的变化是管腔形态多样性的原因，但临床难以获得病理标本，无法根据病理类型选择治疗方案。脑血管造影(DSA)是影像学诊断和随访的金标准，但仅显示管腔的形态学改变，缺乏结合管壁结构的观察研究，不利于认识颅内夹层动脉瘤的病理特征和动态变化。课题组前期应用3T核磁共振(MR)和DSA综合评价颅内夹层动脉瘤管壁和管腔的特征，发现3T MR能显示管壁结构特点，有助理解不同管腔形态变化的病理特征；前期证实血流动力学因素在脑动脉瘤的发展和转归中的重要作用。本研究拟应用多模式3T MR结合DSA获得颅内夹层动脉瘤管壁和管腔影像，行定性、定量分析及随访研究，建立动态变化的影像学特征和病理变化的关联；并利用血流动力学分析其动态变化的机制。本研究对于全面认识颅内夹层动脉瘤动态变化机制和相应影像学特征，指导临床决策有重大意义。

中文关键词： 颅内夹层动脉瘤；核磁共振成像；定量分析；随访；血流动力学

英文摘要： Intracranial dissecting aneurysm (IDA) is one of the most intractable cerebral vascular diseases. Although the evolution of imaging has led to an increased diagnosis of IDA in recent decades, optimal management of this disorder is still unclear and somewhat controversial. IDAs differ from intracranial saccular aneurysms in a number of ways and are progressive lesions. It is found that the lumen wall pathology features are the cause of morphological changes by autopsy. Understanding the pathological status of a dissecting aneurysm may be important for speculating its possible outcome and choosing rational treatment strategies. However, evaluation of the underlying pathological status of such lesions is challenging during clinical work due to the difficulty in obtaining in vivo pathological species of IDA. Digital subtraction angiograph (DSA), which shows geometric shapes of the affected artery instead of imaging features of the lumen wall, has long been the criterion standard for the diagnosis and follow-up. It hampered to comprehensive assess the dynamic changes of intracranial dissecting aneurysm due to lack of observation combined arterial wall structure with lumen. Recently 3T high-resolution magnetic resonance imaging (HR-MRI) is a noninvasive imaging technique that provides a delineation of the arterial wall. We have investigated vessel wall imaging features combined with the luminal shapes of IDAs by 3T HR-MRI and DSA. Our research team testified that 3T HR-MRI combined with DSA offered clear visualization of vessel wall features and accurate assessment of the lumen in IDAs. This combined approach would be highly useful for understanding the underlying pathological status of IDAs. Because IDAs have a characteristic of dynamic changes, quantitative analysis and follow-up studies is important to objectively assess the dynamic changes of IDAs. We also testified that hemodynamic factors play an important role in aneurysm growth and outcome after treatment. On the basis of the preliminary work of our research teams, we suppose that imaging characteristics of IDAs and corresponding the possible mechanism of progressive lesions could help determine treatment strategies. We are planning to carry out quantitative and qualitative analysis and follow-up researches of the dynamics changes of IDA by 3T MRI and DSA and make computational fluid dynamics research. The conclusion made by our researches will be contributive to profoundly understand the dynamic changes of IDAs and predict the outcomes of the lesions. It is also beneficial to understand pathological status of such lesions, identify high-risk patients and guide treatment strategies.

英文关键词： intracranial dissecting aneurysm;magnetic resonance imaging;quantitative analysis;follow-up;hemodynamic