基于CTA的破裂与未破裂前交通动脉瘤形态学参数对比

目的 分析破裂与未破裂前交通动脉瘤的形态学特征，探讨影响前交通动脉瘤破裂的形态学因素。方法 回顾性分析诊断为前交通动脉瘤的114例患者共114个前交通动脉瘤的资料，其中破裂组88个，未破裂组26个。记录CTA图像中动脉瘤的形状、长径、单发或多发、瘤颈宽度、瘤体宽度、纵横比（AR）、动脉瘤倾斜角及血流夹角、大脑前动脉A1段血管构象和动脉瘤指向，对以上因素进行单因素分析及Logistic回归分析。结果 破裂组与未破裂组前交通动脉瘤单发/多发（P=0.001）、动脉瘤形状（P=0.002）、瘤颈宽度（P<0.001）、长径（P<0.001）、瘤体宽度（P<0.001）、AR值（P=0.014）、血流夹角（P<0.001）和单侧A1优势型发生率（P=0.023）差异均有统计学意义。Logistic回归分析中，瘤颈宽度（OR=2.950，P=0.022）、AR（OR=6.206，P=0.022）、血流夹角（OR=1.121，P<0.001）是前交通动脉瘤破裂的独立危险因素，对其均具有正向影响；ROC曲线分析显示敏感度（76.1%）、特异度最大时（88.5%）对应血流夹角为126.65°。结论 瘤颈宽度、AR值和血流夹角是前交通动脉瘤破裂的独立危险因素，瘤颈越宽、AR值越大、血流夹角越大前交通动脉瘤破裂风险越高，可将血流夹角=126.65°作为判断前交通动脉瘤破裂风险的临界值。

Comprision of morphological analysis for ruptured and unruptured anterior communicating artery aneurysms with CTA

Objective To investigate the morphological characteristics of anterior communicating artery aneurysm, and explore the morphological factors of aneurysm rupture. Methods A total of 114 patients with 114 anterior communicating artery aneurysms were retrospectively reviewed, 88 of them were ruptured group and 26 of them were unruptured group. Morphological characteristics were evaluated by CTA, including single or multiple aneurysm, aneurysm shape, aneurysm diameter, width of neck, width of aneurysm, aspect ratio (AR), aneurysm angle, flow angle, dominance of the A1 segment, direction of the aneurysm dome, which were statistical assessed with univariate analysis and Logistic regression analysis. Results Single or multiple aneurysm (P=0.001), aneurysm shape (P=0.002), width of neck (P<0.001), aneurysm diameter (P<0.001), aneurysm width (P<0.001), AR (P=0.014), flow angle (P<0.001), dominance of the A1 segment (P=0.023) were significantly different between two groups. Multivariate Logistic regression analysis showed that width of neck (OR=2.950, P=0.022), AR (OR=6.206, P=0.022) and flow angle (OR=1.121, P<0.001) were independent predictive factors for the rupture of anterior communicating artery aneurysms. The ROC curve analysis showed the flow angle was 126.65° when the highest sensitivity and specificity were 76.1% and 88.5%. Conclusion Width of neck, AR and flow angle are independent predictive factors for the rupture of anterior communicating artery aneurysms, and flow angle is 126.65° may be the optimal threshold of rupture of the anterior communicating artery aneurysms.