摘要
目的探讨颅内小型动脉瘤的破裂与其影像解剖特征的关系,建立动脉瘤破裂风险评分的预测模型,为颅内小型动脉瘤破裂高危患者的早期识别干预提供参考。方法回顾性分析2015年1月—2020年5月郑州大学附属郑州中心医院经头颈CT血管造影或全脑血管造影证实的182例颅内小型动脉瘤(最大径<5 mm)患者的临床资料,其中男62例、女120例,年龄31~83(56.85±11.51)岁,动脉瘤破裂组95例、未破裂组87例。两组患者动脉瘤的部位、形状、有无子囊、生长方向及相关解剖学参数等临床特征和影像解剖特征的比较采用单因素分析方法;动脉瘤破裂的独立危险因素分析采用多因素logistic分析方法,建立动脉瘤破裂的影像解剖特征的预测模型。结果两组患者基线资料比较差异均无统计学意义(P值均>0.05)。单因素分析显示,两组间动脉瘤部位、瘤壁形状、子囊、入射夹角、瘤高与瘤颈的比值(AR)差异均有统计学意义(P值均<0.05)。多因素logistic回归分析显示,有子囊、入射夹角>117.75°、AR值>1.65是动脉瘤破裂的独立危险因素(P值均<0.01)。根据logistic预测模型,其动脉瘤破裂风险评分(R),受试者操作特征曲线下面积为0.812(95%可信区间0.750~0.874,P<0.01),R=2为最佳截断值,灵敏度72.6%,特异度78.2%。结论颅内小型未破裂动脉瘤患者符合以下两种及两种以上影像解剖特征者,即动脉瘤位于颈内动脉后交通段或前交通动脉、瘤壁不规则、有子囊、入射夹角>117.75°、AR值>1.65等,为动脉瘤破裂的高危人群。
Objective To explore the relationship between the rupture of small intracranial aneurysms and their anatomical features,and establish the prediction model for assessing the risk score of the rupture of aneurysms to provide references for the intervention of small intracranial aneurysms.Methods Data of 182 cases with small intracranial aneurysms were analyzed retrospectively,which was confirmed by computed tomography angiography or digital subtraction angiography in Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2015 to May 2020.In this study,62 males and 120 females,aged 31-83(56.85±11.51)years were included.The patients were divided into rupture aneurysm group(95 cases)and unruptured group(87 cases).Univariate analysis was used to analyze the clinical features and imaging anatomical data.Multivariate logistic regression analysis was used to analyze the independent risk factors for ruptured intracranial aneurysms,and the prediction model for assessing the risk score of aneurysm rupture was established.Results Univariate analysis showed that statistically significant differences in aneurysm location,morphology,asci of aneurysm,inflow angle,and aspect ratio(AR)value existed between the two groups(all P values<0.05).Multivariate logistic regression analysis disclosed that asci of aneurysm,inflow angle>117.75°,and AR value>1.65 were the independent risk factors for the rupture of intracranial aneurysms(all P values<0.01).The area under the receiver operator characteristic curve of aneurysm rupture risk score(R)based on the logistic prediction model was 0.812(95%confidence interval 0.750-0.874,P<0.01),R=2 was the best cut-off value,sensitivity was 72.6%,and specificity was 78.2%.Conclusions Patients with small unruptured intracranial aneurysms have two or more imaging anatomical characteristics,such as aneurysm located in the posterior communicating segment of the internal carotid artery or anterior communicating artery,irregular shape,with capsule,inflow angle>117.75°,and AR value>1.65,are high-risk groups of aneurysm rupture.
作者
王天玉
时伟玉
刘俊中
毛立武
郭广涛
赵磊
李天晓
贺迎坤
王圣杰
祝晓川
许恒
Wang Tianyu;Shi Weiyu;Liu Junzhong;Mao Liwu;Guo Guangtao;Zhao Lei;Li Tianxiao;He Yingkun;Wang Shengjie;Zhu Xiaochuan;Xu Heng(Department of Neurointervention,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China;Department of Cerebrovascular Interventional,Henan Provincial People's Hospital,Zhengzhou 450000,China)
出处
《中华解剖与临床杂志》
2021年第3期287-292,共6页
Chinese Journal of Anatomy and Clinics
基金
河南省高等学校重点科研项目资助计划(21A320002)。
关键词
颅内动脉瘤
颅内小型动脉瘤
影像解剖特征
血管造影术
Intracranial aneurysm
Small intracranial aneurysm
Image anatomical features
Angiography
