颅内动脉瘤心动周期内膨胀率与其破裂的相关性研究

目的 基于四维计算机X线断层扫描(Computed tomography,CT)血管成像(Dynamic four-dimensional CTA,4D-CTA)测量,计算颅内动脉瘤心动周期内膨胀率,探讨颅内动脉瘤破裂与膨胀率的相关性。方法 回顾性分析2018年5月-2020年5月就诊于哈尔滨医科大学附属第四医院微创神经外科一病区64例(其中未破裂动脉瘤24个,破裂动脉瘤40个)患者的完整资料; 所有患者均行4D-CTA扫描并重建图像; 依据动脉瘤破裂与否,患者分为未破裂组、破裂组; 将1个心动周期的图像数据分成20个阶段,判断动脉瘤是否存在异常搏动点; 同时记录和量化每个阶段动脉瘤的形态特征,计算其体积变化率(膨胀率); 分析动脉瘤破裂相关的危险因素。结果 未破裂组中男女患者比例差异不大; 破裂组女性患者则占70%,女性患者比例显著高于男性; 破裂组吸烟史的比例明显高于未破裂组; 破裂组瘤高(4.63±1.56)mm,瘤宽(4.72±3.68)mm,瘤颈宽(3.86±1.69)mm均大于未破裂组; 破裂组异常搏动点有29个(占72.5%)、膨胀率(14.56±6.25)%; 未破裂组异常搏动点13个(占54.2%)、膨胀率(10.21±3.26)%; 2组有明显差异(P<0.05)。此外,多因素Logistic回归分析显示动脉瘤破裂与吸烟史、纵横比、异常搏动点、膨胀率有关(P<0.05)。ROC分析中纵横比临界值为1.145(P=0.002),灵敏度为77.5%,特异性为58.3%; 存在异常搏动点与否的阈值为0.5(P=0.032),灵敏度为72.5%、特异性为45.8%; 膨胀率的临界值为9.775%(P=0.001),灵敏度为85.0%、特异性为54.2%。结论 借助4D-CTA能观察心动周期内颅内动脉瘤动态变化; 本研究成功量化了动脉瘤膨胀率,颅内动脉瘤破裂与膨胀率有关; 当膨胀率>9.775%,或纵横比>1.145,或存在异常搏动点时动脉瘤破裂风险将进一步增加。

Correlation between expansion rate in a cardiac cycle and rupture of intracranial aneurysms

Objective Based on dynamic four-dimensional computed tomographic angiography(4D-CTA)measurement, the expansion rateof intracranial aneurysm was calculated, and the correlation between intracranial aneurysm rupture and expansion rate was discussed.Methods The complete records of 64 patients(24 unruptured aneurysms and 40 ruptured aneurysms)in a minimally invasive neurosurgery area of the fourth Hospital of Harbin Medical University from May 2018 to May 2020 were retrospectively analyzed. All patients underwent cranial 4D-CTA scan andimageswere reconstructed. The patients were divided into unruptured group and ruptured group, depending on whether theintracranial aneurysms were ruptured or not. The image data of a cardiac cycle was divided into 20 stages to check whether the aneurysm has an abnormal pulsation point. Meanwhile, the morphological characteristics of aneurysms at each stagewererecorded and quantified, and their volume change rate(expansion rate)was calculated. The riskfactors of aneurysm rupture were analyzed by statistics.Results There was no difference in sex ratio in the unruptured group, while the proportion offemale patients in the ruptured group was about 70% which was significantly higher than that of male patients. The rate of hypertension, diabetes and smoking history in ruptured group was significantly higher than that in unruptured group. Ruptured aneurysms have the characteristics that the height of aneurysms was 4.63±1.56 mm, the width was 4.72±3.68 mm, the neck width was 3.86±1.69 mm. All ofthese values inruptured aneurysms were more than these of unruptured aneurysms. In ruptured group abnormal pulsation points of aneurysmswere 29(72.5%), expansion rate was 14.56±6.25%, while in unruptured group they were 13(54.2%)and 10.21±3.26% respectively. There were significant differences in these factors between the two groups. In addition, it showed that aneurysm rupture was correlated with smoking history, aspect ratio, abnormal pulsation points and expansion rate by multivariate logistic regression analysis(P<0.05). By ROC curve analysis, a critical aspect ratio was 1.145(P=0.002), and the sensitivity and specificity were 77.5% and 58.3%. Threshold value of existence of abnormal pulsating point was 0.5(P=0.032), and the sensitivity and specificity were 72.5% and 45.8%. The critical value of expansion rate was 9.775%(P=0.001), and the sensitivity and specificity were 85.0% and 54.2%.Conclusion Dynamicstates of intracranial aneurysms during a cardiac cycle can be observed by 4D-CTA. The expansion rate of aneurysm was successfully quantified, and the rupture of intracranial aneurysm was correlated with the expansion rate. If the expansion rate wasmore than 9.775%, the aspect ratio was more than 1.145 or there was an abnormal pulsation point, therupture risk of aneurysm would be further increased.