未破裂颅内动脉瘤的研究进展

未破裂颅内动脉瘤（UIA）多因患者出现头痛或头晕等不适而行头颅影像检查时发现。UIA在普通人群中的患病率为1%～2%,但UIA的相关机制及破裂风险尚不统一,其中,动脉瘤性蛛网膜下腔出血（SAH）是较为严重的并发症,越来越引起人们的关注。因此,了解UIA破裂的影响因素、并发症发生率以及干预效果很重要。本文就UIA的患病率、危险因素、影像学监测作用以及UIA的筛查、治疗等进行综述。     

高分辨率MR血管壁成像测量壁强化指数评估颅内动脉瘤不稳定性

目的探讨高分辨率MR(HRMR)血管壁成像(VWI)所测壁强化指数(WEI)评估颅内动脉瘤不稳定性的价值。方法回顾性分析174例未破裂颅内动脉瘤患者。以3D-DSA观察动脉瘤大小、位置、形态。基于HRMR血管壁成像主观评估是否有动脉瘤壁强化(AWE),并采用软件计算WEI。采用ELAPSS及PHASES评分评估动脉瘤生长风险及破裂风险。以Spearman相关分析观察WEI与动脉瘤生长及破裂风险的相关性。结果 174例患者共248个无症状未破裂颅内囊状动脉瘤,HRMR VWI示AWE 78个、无AWE 170个。AWE与无AWE动脉瘤大小、位置、形态、ELAPSS评分、生长风险、PHASES评分、5年破裂风险差异均有统计学意义(P均0.05)。AWE动脉瘤WEI高于无AWE动脉瘤(P0.001)。Spearman相关分析显示,WEI与动脉瘤3年、5年生长风险(r_s=0.40、0.40,P均0.01)及5年破裂风险(r_s=0.24,P0.01)均呈正相关。结论 HRMR VWI所测WEI越高,提示动脉瘤不稳定性越高。     

未破裂颅内动脉瘤直径与其血流动力学、形态学及瘤壁强化的关系

目的 观察未破裂颅内动脉瘤（UIA）直径与其血流动力学、形态学及瘤壁强化（AWE）的关系。方法 对前瞻性纳入的85例UIA患者行数字减影血管造影（DSA）、高分辨率MR管壁成像（HRMR-VWI）及四维血流MRI （4D flow MRI）,观察其100枚UIA的血流动力学、形态学及AWE,计算UIA纵横比（AR）、大小比（SR）、顶颈比（DNR）、高宽比（HWR）、强化率（ER）及壁面切应力（WSS）;比较直径<7 mm （n=78）及≥ 7 mm （n=22） UIA各参数的差异。结果 直径<7 mm与≥ 7 mm UIA患者既往蛛网膜下腔出血（SAH）史、动脉瘤相关症状、SR、DNR、形态、AWE、ER及WSS差异均有统计学意义（P均<0.05）。多因素logistic回归分析显示,既往SAH史、UIA的SR、形态及ER为其直径≥ 7 mm的独立危险因素。WSS与UIA直径、SR及ER均呈负相关（r=-0.70、-0.67、-0.63,P均<0.001）。观察者间判断AWE的一致性极高（Kappa=0.87）,测量ER及WSS的一致性均好（ICC=0.946、0.871,P均<0.001）。结论 既往SAH史,UIA的SR、形态及ER均为其直径≥ 7 mm的独立危险因素。     

未破裂颅内动脉瘤72例临床分析

目的 探讨未破裂颅内动脉瘤的处理方式及其疗效,以指导临床治疗.方法 回顾性分析我科收治的72例未破裂颅内动脉瘤的患者,所有患者均行DSA或CTA明确诊断,采用血管内栓塞治疗、开颅手术夹闭或者观察三种治疗策略,对比分析其疗效.结果 血管内栓塞治疗15例,手术夹闭40例.出院时GOS评分5分血管内介入治疗组14例（93.3%）,开颅手术夹闭组31例（77.5%）.两组患者治疗后出院前行GOS评分经卡方检验无明显差异（P＆gt;0.05）.观察随诊处理17例,无变化15例,再出血2例.结论 根据未破裂动脉瘤的特点、患者自身状况及要求、就诊中心诊疗技术等决定未破裂动脉瘤的治疗方式,个体化治疗是最佳的治疗方案.     

零回波时间动脉自旋标记MR血管成像评估颅内动脉瘤

目的 观察零回波时间(ZTE)动脉自旋标记(ASL)MR血管成像(MRA)评估颅内动脉瘤(IA)的价值。方法 对18例临床疑诊IA患者行头颈部时间飞跃法(TOF)MRA(TOF-MRA)及ZTE ASL-MRA,并于之后2天内行头颈部数字减影血管造影(DSA);评价2种MRA图像显示IA质量(优、良、中等或差)及IA定量参数(瘤高、瘤宽及瘤颈),比较其图像质量评分差异;以DSA结果为金标准,采用组内相关系数(ICC)观察3种检查所获IA定量参数的一致性。结果 18例共21个IA纳入研究。ZTE ASL-MRA显示IA图像质量评分[4(4,4)]高于TOF-MRA[4(3,4),Z=－2.40,P=0.02]。ZTE ASL-MRA(ICC=0.99、0.98、0.99)及TOF-MRA(ICC=0.96、0.96、0.93)所示IA瘤高、瘤宽及瘤颈与DSA结果的一致性均强(P均<0.05)。结论 ZTE ASL-MRA可用于无创、定量评估IA。     

支架辅助栓塞未破裂颅内动脉瘤术后颅内微缺血危险因素

目的分析支架辅助栓塞(SAE)治疗未破裂颅内动脉瘤后发生颅内微缺血(IMI)的危险因素。方法回顾性分析236例接受SAE治疗的未破裂颅内动脉瘤患者,根据术后3天内头部MR弥散加权成像(DWI)检查结果判断是否发生IMI;采用单因素分析和多因素Logistic回归分析筛选IMI危险因素。结果 236例中,97例(97/236, 41.10%)发生IMI(IMI组),139例未发生IMI(非IMI组,n=139)。2组间合并糖尿病、缺血性卒中病史、血小板抑制不足、前交通动脉瘤、伴瘤内附壁血栓、支架贴壁不良及微弹簧圈襻疝出瘤囊差异有统计学意义(P均0.05)。多因素Logistic回归分析结果显示,血小板抑制不足、前交通动脉瘤、伴瘤内附壁血栓、支架贴壁不良及微弹簧圈襻疝出瘤囊是IMI的独立危险因素(P均0.05)。结论 SAE治疗未破裂颅内动脉瘤后可发生IMI;血小板抑制不足、前交通动脉瘤、伴瘤内附壁血栓、支架贴壁不良及微弹簧圈襻疝出瘤囊促进IMI发生。     

16例应用磁共振诊断颅内动脉瘤临床研究

目的对应用MRI诊断颅内动脉瘤进行研究。方法选取2008年8月～2010年8月就诊的16例颅内动脉瘤患者,其中男6例,女10例。所有病例均经临床或DSA检查证实,均行MRI平扫及增强扫描。结果患者中共发现动脉瘤16处,均为单发,位于鞍上池附近,圆形或类圆形,境界尚清,其中最小的约0.7cm×0.5cm×0.5cm,最大的约2.7cm×2.0cm×2.5cm。信号混杂,T1WI以等、高信号为主,T2WI为低、等或高信号。结论 MRI扫描能够显示动脉瘤以及其与周围的关系,帮助判断动脉瘤蒂的位置及大小,还可以显示整个脑血管系统,对颅内动脉瘤的诊断具有重要价值。     

破裂颅内动脉瘤夹闭术的麻醉处理

我院自1998年1月～2006年12月共实施破裂动脉瘤夹闭术90例,现将破裂颅内动脉瘤夹闭术的麻醉处理总结如下。     

颅内动脉瘤——颅内外动脉搭桥术在治疗颅内动脉瘤中的价值

显微神经外科技术和血管内治疗技术的进展使越来越多的颅内动脉瘤得以治愈，但是，仍有一部分颅内动脉瘤，主要为颅内巨大动脉瘤，因生长部位、瘤颈宽大或呈梭形生长等原因，难以通过手术或血管内治疗处理。在这种情况下，牺牲载瘤动脉的动脉瘤孤立术就成为治疗的可选方式。但对颅内侧支循环发育不良的病例，牺牲载瘤动脉可能导致术后缺血性脑梗塞。Yasargil等在动物实验的基础上，于1967年与Donaghy等先后推出STA-MCA搭桥术用于颅内闭塞性脑血管病的治疗，     

Motion and image artifacts of various intracranial aneurysm clips in a magnetic field

Summary Deflection angles of 36 types of Sugita intracranial aneurysm clips (Elgiloy), 2 types of Yasargil clips (Phynox), A Kirschner chip (SUS316) and a silver clip were examined by suspending each in a 1.5-tesla MRI (TOSHIBA MRT-200/FXII). Image artifacts of 5 types of intracranial aneurysm clips were also studied quantitatively with respect to their ratio of artifcat/actual clip size using a spin-echo sequence with T1-weighted (Time of repetition (TR)=500 ms, Time of echo (TE)=20 ms) and T2-weighted (TR=2000 ms, TE=80 ms) images.All the Sugita clips from mini type to long type showed a deflection angle of less than 1.0 degree, the Yasargil clips less than 2.0 degrees, the Kirschner chip less than 6.0 degrees, and the silver chip did not move at all. Both brands of clips are therefore suitable for intracranial applications.The artifact size was directly proportional to the clip size and weight, though the ratio of artifact/actual width tended to decrease proportionately as the actual size and weight increased. The ratio of the width seemed slightly bigger than that of the length, but the difference did not reach statistical significance. There was no significant difference in the ratio of image artifacts/clip size between T1- and T2-weighted images.     

颅内动脉瘤研究现状

颅内动脉瘤是脑血管系统的有破裂倾向的局灶性病理扩张,其破裂可致脑蛛网膜下腔出血.对其病因学的研究,有望揭示动脉瘤发病的生物学机制,为其早期预防和治疗提供依据.本文对近年来颅内动脉瘤的研究现状做一综述.     

Giant serpentine intracranial aneurysm

Giant serpentine aneurysms are considered a distinct sub-group of giant aneurysms because of their characteristic angiographic appearance and clinical behavior. A case of this unusual vascular abnormality showing progressive enlargement documented by computed tomography and cerebral angiography is presented, along with a review of the literature. Etiology, pertinent radiological findings, and a probable mechanism of serpentine channel formation are discussed.     

颅内动脉瘤夹闭术后影像学随访研究进展

颅内动脉瘤是一种发生率、致死率及致残率高的脑血管疾病。其主要治疗方式是动脉瘤夹闭术,但动脉瘤夹闭术后并发症较多,主要有动脉瘤夹闭不全、瘤夹脱落、脑梗死、载瘤动脉及周围血管狭窄或闭塞、脑血管痉挛以及动脉瘤再出血、再生、新生、硬膜外血肿等,需进行长期随访。颅内动脉瘤夹闭术后随访的影像学检查主要有DSA、MRA、CTA,本文对颅内动脉瘤夹闭术后随访的影像学进展进行综述。     

Risk factors for the association of intracranial and aortic aneurysms

Summary This study investigated the association of intracranial aneurysms and abdominal aortic aneurysms to elucidate the incidence and independent risk factors for this association. Ultrasonography of the abdominal aorta was performed in 181 patients with 224 intracranial aneurysms. Six patients had suffered subarachnoid haemorrhage and the others had chronic disease or no symptoms. Magnetic resonance angiography was performed for confirmation if abdominal aortic aneurysm was identified by ultrasonography. Thirteen patients (7.2%) with 23 intracranial aneurysms had abdominal aortic aneurysms. Univariate analysis demonstrated that age (p < 0.01), size of intracranial aneurysms (p < 0.001), male sex (p < 0.01), multiplicity of intracranial aneurysms (p < 0.001), history of cerebrovascular diseases (p < 0.05), and current smoking (p < 0.0001) were significantly different between patients with and without this association. Multiple logistic analysis indicated that age (odds ratio [OR] 1.27, 95% confidence interval 1.08–1.48, p < 0.01), multiplicity (OR 22.1, 95% confidence interval 1.83–266.3, p = 0.01), size of intracranial aneurysms (OR 1.30, 95% confidence interval 1.10–0.54, p < 0.01), and current smoking (OR 33.3, 95% confidence interval 2.43–456.7, p = 0.01) were independent risk factors for the association. Patients with intracranial aneurysms who are older males with multiple or large intracranial aneurysms, and current smokers should be examined for abdominal aortic aneurysms using ultrasonography.