基于冠状动脉血管分支流量分配方法的血流储备分数数值模拟研究
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摘要
目的在个性化无创计算血流储备分数(fractional flow reverse,FFRCT)中,流量边界条件的分配准确性往往是一个问题。本文基于种内标度律,提出了一种体积-流量关系的冠脉血流量分配方法进行血流量分配。方法对16例患者冠状动脉血管造影(CT angiography,CTA)图像进行重建,测量出各分支的体积,再经过标度律的方法将冠脉总流量以体积分配比分配到各分支出口。以临床FFR值和最终计算的血流动力学模拟值作分类对比,比较以往的管径流量模型分配方法和体积流量分配方法的准确性。结果基于体积法计算的FFRCT误差为10. 47%,基于管径法计算的FFRCT为11. 76%,并且体积分配方法与管径分配方法具有较好的一致性(80%)。结论本文结果可为临床无创检测FFR提出新的计算方法,并推动FFRCT的临床应用研究。
Objective For the personalized non-invasive calculation of fractional flow reverse( FFRCT),the accuracy of the distribution of flow boundary conditions is a key issue. According to the intra-species scaling law,we propose a volume-flow relationship based coronary blood flow distribution method for blood flow in coronary branches. Methods The CT angiography( CTA) images of 16 patients were reconstructed,and the volume of each branch of the patient was measured. The total volume of the coronary artery was distributed to each branch outlet by volumetric ratio. The clinical FFR values and the final calculated hemodynamic simulation values were compared,and the accuracy of the commonly used diameter flow model and volume flow distribution method was compared. Results The FFFCTerror calculated by the volume method and by the diameter method was10. 47% and 11. 76% respectively, and the volume distribution method had the same consistency( 80%) with the diameter distribution method. Conclusions This work may provide a new calculation method for clinical non-invasive detection FFR and promote the clinical application of FFRCT.
Objective For the personalized non-invasive calculation of fractional flow reverse( FFRCT),the accuracy of the distribution of flow boundary conditions is a key issue. According to the intra-species scaling law,we propose a volume-flow relationship based coronary blood flow distribution method for blood flow in coronary branches. Methods The CT angiography( CTA) images of 16 patients were reconstructed,and the volume of each branch of the patient was measured. The total volume of the coronary artery was distributed to each branch outlet by volumetric ratio. The clinical FFR values and the final calculated hemodynamic simulation values were compared,and the accuracy of the commonly used diameter flow model and volume flow distribution method was compared. Results The FFFCTerror calculated by the volume method and by the diameter method was10. 47% and 11. 76% respectively, and the volume distribution method had the same consistency( 80%) with the diameter distribution method. Conclusions This work may provide a new calculation method for clinical non-invasive detection FFR and promote the clinical application of FFRCT.
引文
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[19]高昊,刘建平,仝识非,等.心肌声学造影对冠脉狭窄临界病变的功能性诊断价值[J].第三军医大学学报,2018,40(7):603-609.Gao H,Liu JP,Tong SF,et al. Functional diagnostic value of myocardial contrast echocardiography for critical lesions of coronary artery stenosis[J]. Journal of Third Military Medical University,2018,40(7):603-609.
[2] West GB,Brown JH,Enquist BJ. A general model for the origin of allometric scaling laws in biology[J]. Science,1997,276(5309):122-126.
[3] Huo Y,Kassab GS. Intraspecific scaling laws of vascular trees[J]. Journal of the Royal Society Interface,2012,9(66):190-200.
[4] Huo Y,Kassab GS. Scaling laws of coronary circulation in health and disease[J]. Journal of Biomechanics,2016,49(12):2531-2539.
[5]姜宗来,何光麓.人冠状动脉的几何形态学[J].第三军医大学学报,1989,11(2):85-91.Jiang ZL,He GL. Geometric Morphology of Human Coronary Artery[J]. Journal of Third Military Medical University,1989(2):85-91.
[6] Miyoshi T,Osawa K,Ito H,et al. Non-invasive computed fractional flow reserve from computed tomography(CT)for diagnosing coronary artery disease-Japanese results from NXT trial(Analysis of coronary blood flow using CT angiography:next steps)[J]. Circulation Journal,2015,79(2):406-412.
[7]乔爱科,侯映映,侯阳.冠状动脉狭窄几何构型对血流储备分数影响的有限元分析[J].中国生物医学工程学报,2015,34(2):198-203.Qiao AK, Hou YY, Hou Y. Finite element analysis of the influence of geometric configuration of coronary artery stenosis on blood flow reserve fraction[J]. Chinese Journal of Biomedical Engineering,2015,34(2):198-203.
[8] Morris PD,Ryan D,Morton AC,et al. Virtual fractional flow reserve from coronary angiography:modeling the significance of coronary lesions:results from the VIRTU-1(virtual fractional flow reserve from coronary angiography)study[J]. JACC Cardiovascular Interventions,2013,6(2):149-157.
[9] Morris PD,van de Vosse FN,et al.“Virtual”(computed)fractional flow reserve[J]. Jacc Cardiovascular Interventions,2015,8(8):1009-1017.
[10] Pijls NH,van Son JA,Kirkeeide RL,et al. Experimental basis of determining maximum coronary,myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty[J]. Circulation,1993,87(4):1354-1367.
[11] Pijls NH,De BB,Peels K,et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses[J]. New England Journal of Medicine,1996,334(26):1703-1708.
[12] Tu S,Echavarriapinto M,Von BC,et al. Fractional flow reserve and coronary bifurcation anatomy:a novel quantitative model to assess and report the stenosis severity of bifurcation lesions[J].Jacc Cardiovasc Interv,2015,8(4):564-574.
[13] Taylor CA,Fonte T A,Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve:scientific basis[J].Journal of the American College of Cardiology,2013,61(22):2233-2241.
[14] Nrgaard BL,Leipsic J,Gaur S,et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease:the NXT trial(analysis of coronary blood flow using CT angiography:next steps)[J]. Journal of the American College of Cardiology,2014,63(12):1145-1155.
[15] Min J K,Taylor CA,Achenbach S,et al. Noninvasive fractional flow reserve derived from coronary CT angiography:clinical data and scientific principles[J]. JACC:Cardiovascular Imaging,2015,8(10):1209-1222.
[16] Uren NG,Melin JA,De BB,et al. Relation between myocardial blood flow and the severity of coronary-artery stenosis[J]. New England Journal of Medicine,1994,330(25):1782-1788.
[17] Zhang JM,Zhong L,Luo T,et al. Simplified models of noninvasive fractional flow reserve based on CT images[J]. Plos One,2016,11(5):e0153070.
[18]李荣娟,苏武锦. Bland-Altman分析法在临床检验方法比较的实例应用和绘图介绍[J].国际检验医学杂志,2013,34(20):2727-2729.Li RJ,Su WJ. An example application and mapping of BlandAltman analysis in the comparison of clinical test methods[J].International Journal of Laboratory Medicine,2013,34(20):2727-2729.
[19]高昊,刘建平,仝识非,等.心肌声学造影对冠脉狭窄临界病变的功能性诊断价值[J].第三军医大学学报,2018,40(7):603-609.Gao H,Liu JP,Tong SF,et al. Functional diagnostic value of myocardial contrast echocardiography for critical lesions of coronary artery stenosis[J]. Journal of Third Military Medical University,2018,40(7):603-609.