作　　者： ; ; ; ; ; ;

机构地区： 汕头大学医学院附属粤北人民医院

出　　处： 《临床放射学杂志》 2017年第1期15-19,共5页

摘　　要： 目的研究颅内动脉瘤(IA)形态学参数与其破裂风险的关系,初探CTA预测动脉瘤破裂的风险。方法搜集本院2014年6月至2015年4月经手术和CTA诊断为动脉瘤的110例患者(129个动脉瘤)。对于多发动脉瘤,依据CT平扫时蛛网膜下腔出血类型或者手术结果判定动脉瘤是否破裂,将其分为破裂组和未破裂组。动脉瘤形态学参数包括瘤颈宽度(N)、瘤体大小及形状、瘤体深度与瘤颈宽度的比值(AR)、瘤体深度与载瘤动脉直径的比值(SR)、瘤颈宽度与载瘤动脉直径的比值(NPR)、动脉瘤面积与瘤颈处载瘤动脉面积的比值。采用单变量和多变量Logistic回归分析计算动脉瘤破裂的独立危险因素。结果 110例IA患者,男29例,女81例,中位年龄(60.6±11.3)岁。IA前三位的好发位置是后交通动脉(46个)、大脑中动脉(30个)、大脑前动脉(26个)。破裂率前三位的位置是后交通动脉(38.6%)、大脑前动脉(25.0%)、大脑中动脉(22.7%)。单变量统计分析显示动脉瘤的大小、位置、AR、SR,面积比值和不规则的瘤壁在破裂组和未破裂组中具有显著差异。以动脉瘤的位置、不规则的瘤壁、性别和年龄作为调节变量,多变量分析显示动脉瘤大小≥3.85(AOR 2.913;95%CI 1.196~7.093),AR≥1.448(AOR 3.118;95%CI 1.230~7.903),SR≥1.388(AOR 5.245;95%CI 1.965~13.998)和面积比≥1.192(AOR 4.407;95%CI 1.569~12.379),是动脉瘤破裂的危险因素。结论大的动脉瘤及其面积比值,高的AR及SR值是独立于动脉瘤位置、瘤壁形态和患者性别、年龄的破裂危险因素。 Objective Using CTA to evaluate the association of the morphological parameters of intracranial aneurysm and its risk of rupture. Methods Between June 2014 and April 2015,a total of 110 patients harboring 129 aneurysms were diagnosed at our hospital by use of CT angiography and surgical finding. Ruptured aneurysms were diagnosed by the pattern of hemorrhage on conventional head CT or surgical findings. Morphological parameters examined for aneurysms comprised aneurysm wall regularity,size,neck width,aspect ratio（ AR）,size ratio（ SR）,neck-to-parent artery ratio（ NPR）and area ratio. Univariate and multivariate statistical analyses were performed to determine independent risk factors for rupture. Results A total of 110 patients（ 81 females） with intracranial aneurysms were included,and had a mean age of60. 6 ± 11. 3years. The top three locations of aneurysm were posterior communicating artery（ 46）,MCA（ 30） and anterior cerebral artery（ 26）,including the anterior communicating artery. While in the ruptured group,posterior communicating artery,anterior cerebral artery（ including the anterior communicating artery）,and middle cerebral artery were the top three locations for aneurysm occurrence,accounting for 38. 6%,25. 0%,22. 7% respectively. Univariate analysis disclosed that aneurysm size,locations,AR,SR,area ratio and irregular wall showed a significant difference between ruptured and unruptured patients. Multivariate analysis disclosed that aneurysm size≥3. 85（ a OR2. 913; 95% CI 1. 196- 7. 093）,AR ≥1. 448（ a OR3. 118; 95% CI 1. 230- 7. 903）,SR≥1. 388（ a OR5. 245; 95% CI 1. 965- 13. 998） and area ratio ≥1. 192（ a OR4. 407; 95% CI 1. 569- 12. 379） were significant predictive factors for aneurysm rupture after adjustment for location,irregular wall,age,sex. Conclusion An aneurysm size≥3. 85,aspect ratio ≥1. 448,SR≥1. 388,and area ratio≥1. 192 are associated with aneurysm rupture independent of aneurysm size,location and patient characteristics.

关 键 词： 颅内动脉瘤 形态学 体层摄影术 线计算机 血管造影术

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