Neurological Surgery 脳神経外科37巻9号

2009年09月発行

総説

脳動脈瘤の血流動態解析

著者： 礒田治夫¹ 平松久弥² 難波宏樹² 平野勝也³ 大倉靖栄⁴ 小杉隆司⁴ 竹田浩康¹ 山下修平¹ 竹原康雄¹ 阪原晴海¹

所属機関： ¹浜松医科大学医学部放射線科 ²浜松医科大学医学部脳神経外科 ³GEヘルスケア・ジャパン株式会社 ⁴株式会社アールテック ⁵スタンフォード大学医学部放射線科

ページ範囲：P.836 - P.845

Ⅰ．はじめに

　脳動脈瘤の発生・増大・破裂にはさまざまな因子が関与しているが，血流動態，特に血管壁剪断応力（wall shear stress：WSS）は重要な要因の1つと考えられる．脳血管や脳動脈瘤のWSSが正確に求められ，しかも，WSSと脳動脈瘤の発生・増大・破裂の関連が明らかになれば，脳動脈瘤の発生予測・予防，脳動脈瘤の予後推定，治療方針決定，治療計画，新しい治療法開発に役立つ可能性がある．

　近年，磁気共鳴撮像法の1つである3次元シネ位相コントラスト磁気共鳴撮像法（3D cine phase-contrast［PC］MRI）を用いた磁気共鳴血流動態解析（magnetic resonance［MR］fluid dynamics：MRFD）によるインビボ（in vivo）血流動態解析が可能となってきた．これを用いた脳動脈瘤血流動態解析，WSS解析を紹介する．

参考文献

1）安藤譲二：血管内皮細胞のバイオメカニクス．30-91（神谷　瞭：循環系のバイオメカニクス．第2章，コロナ社，東京，2005）

2）Bammer R, Hope TA, Aksoy M, Alley MT：Time-resolved 3D quantitative flow MRI of the major intracranial vessels：initial experience and comparative evaluation at 1.5T and 3.0T in combination with parallel imaging. Magn Reson Med 57：127-140, 2007

3）Boussel L, Rayz V, McCulloch C, Martin A, Acevedo-Bolton G, Lawton M, Higashida R, Smith WS, Young WL, Saloner D：Aneurysm growth occurs at region of low wall shear stress：patient-specific correlation of hemodynamics and growth in a longitudinal study. Stroke 39：2997-3002, 2008

4）Castro MA, Putman CM, Sheridan MJ, Cebral JR：Hemodynamic patterns of anterior communicating artery aneurysms：a possible association with rupture. AJNR Am J Neuroradiol 30：297-302, 2009

5）Cebral JR, Castro MA, Burgess JE, Pergolizzi RS, Sheridan MJ, Putman CM：Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. AJNR Am J Neuroradiol 26：2550-2559, 2005

6）Hassan T, Timofeev EV, Saito T, Shimizu H, Ezura M, Tominaga T, Takahashi A, Takayama K：Computational replicas：anatomic reconstructions of cerebral vessels as volume numerical grids at three-dimensional angiography. AJNR Am J Neuroradiol 25：1356-1365, 2004

7）He X, Ku DN：Pulsatile flow in the human left coronary artery bifurcation：average conditions. J Biomech Eng 118：74-82, 1996

8）Isoda H, Hirano M, Takeda H, Kosugi T, Alley MT, Markl M, Pelc NJ, Sakahara H：Visualization of hemodynamics in a silicon aneurysm model using time-resolved, 3D, phase-contrast MRI. AJNR Am J Neuroradiol 27：1119-1122, 2006

9）礒田治夫，大倉靖栄，瀬尾太郎，小杉隆司，竹田浩康，平野勝也，山下修平，稲川正一，竹原康雄，野崎　敦，永澤　清，Marcus T. Alley，Norbert J. Pelc，阪原晴海：Time-Resolved Three-Dimensional Phase-Contrast MRIを用いたヒト脳動脈瘤インビボ血流解析の初期検討．日磁医誌27：13-17, 2007

10）礒田治夫，竹田浩康，山下修平，竹原康雄，稲川正一，阪原晴海，大倉靖栄，小杉隆司，平野勝也：CINE Phase-Contrast MRIを用いたヒト脳動脈瘤インビボ血流解析．GE today 29-32, 2007

11）礒田治夫，平野勝也，竹田浩康，大倉靖栄，小杉隆司，山下修平，竹原康雄，難波宏樹，Marcus T. Alley，阪原晴海：MRによる脳動脈瘤血流解析．臨放53：797-808, 2008

12）礒田治夫，大倉靖栄，小杉隆司，山下修平，竹原康雄，竹田浩康，平野勝也，難波宏樹，Marcus T. Alley，Roland Bammer，Norbert J Pelc5，阪原晴海：脳動脈瘤の3D cine PC MRI流体解析とこれを境界条件とした計算流体力学解析の比較．日磁医誌29：33-36, 2009

13）Jou LD, Wong G, Dispensa B, Lawton MT, Higashida RT, Young WL, Saloner D：Correlation between lumenal geometry changes and hemodynamics in fusiform intracranial aneurysms. AJNR Am J Neuroradiol 26：2357-2363, 2005

14）Jou LD, Lee DH, Morsi H, Mawad ME：Wall shear stress on ruptured and unruptured intracranial aneurysms at the internal carotid artery. AJNR Am J Neuroradiol 29：1761-1767, 2008

15）Ku DN, Giddens DP, Zarins CK, Glagov S：Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress. Arteriosclerosis 5：293-302, 1985

16）Malek AM, Alper SL, Izumo S：Hemodynamic shear stress and its role in atherosclerosis. JAMA 282：2035-2042, 1999

17）Mantha A, Karmonik C, Benndorf G, Strother C, Metcalfe R：Hemodynamics in a cerebral artery before and after the formation of an aneurysm. AJNR Am J Neuroradiol 27：1113-1118, 2006

18）Markl M, Chan FP, Alley MT, Wedding KL, Draney MT, Elkins CJ, Parker DW, Wicker R, Taylor CA, Herfkens RJ, Pelc NJ：Time-resolved three-dimensional phase-contrast MRI. J Magn Reson Imaging 17：499-506, 2003

19）Meng H, Wang Z, Hoi Y, Gao L, Metaxa E, Swartz DD, Kolega J：Complex hemodynamics at the apex of an arterial bifurcation induces vascular remodeling resembling cerebral aneurysm initiation. Stroke 38：1924-1931, 2007

20）Ohshima T, Miyachi S, Hattori K, Takahashi I, Ishii K, Izumi T, Yoshida J：Risk of aneurysmal rupture：the importance of neck orifice positioning-assessment using computational flow simulation. Neurosurgery 62：767-773, 2008

21）Sho E, Sho M, Singh TM, Xu C, Zarins CK, Masuda H：Blood flow decrease induces apoptosis of endothelial cells in previously dilated arteries resulting from chronic high blood flow. Arterioscler Thromb Vasc Biol 21：1139-1145, 2001

22）Shojima M, Oshima M, Takagi K, Torii R, Hayakawa M, Katada K, Morita A, Kirino T：Magnitude and role of wall shear stress on cerebral aneurysm：computational fluid dynamic study of 20 middle cerebral artery aneurysms. Stroke 35：2500-2505, 2004

23）Szikora I, Paal G, Ugron A, Nasztanovics F, Marosfoi M, Berentei Z, Kulcsar Z, Lee W, Bojtar I, Nyary I：Impact of aneurysmal geometry on intraaneurysmal flow：a computerized flow simulation study. Neuroradiology 50：411-21, 2008

24）Tateshima S, Murayama Y, Villablanca JP, Morino T, Nomura K, Tanishita K, Viñuela F：In vitro measurement of fluid-induced wall shear stress in unruptured cerebral aneurysms harboring blebs. Stroke 34：187-192, 2003

25）Ujiie H, Tachibana H, Hiramatsu O, Hazel AL, Matsumoto T, Ogasawara Y, Nakajima H, Hori T, Takakura K, Kajiya F：Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms：a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45：119-129, 1999

26）Valencia A, Morales H, Rivera R, Bravo E, Galvez M：Blood flow dynamics in patient-specific cerebral aneurysm models：the relationship between wall shear stress and aneurysm area index. Med Eng Phys 30：329-340, 2008

27）Yamashita S, Isoda H, Hirano M, Takeda H, Inagawa S, Takehara Y, Alley MT, Markl M, Pelc NJ, Sakahara H：Visualization of hemodynamics in intracranial arteries using time-resolved three-dimensional phase-contrast MRI. J Magn Reson Imaging 25：473-478, 2007