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。

Wall enhancement index measured with high resolution MR vessel wall imaging for evaluating instability of intracranial aneurysm

Objective To explore the value of wall enhancement index (WEI) measured with high resolution MR (HRMR) vessel wall imaging (VWI) for evaluating the instability of intracranial aneurysms. Methods Data of 174 patients with unruptured intracranial aneurysms were retrospectively analyzed. 3D-DSA was used to display the size, location and shape of aneurysms. Subjective assessment of aneurysm wall enhancement (AWE) was performed based on HRMR VWI, and wall enhancement index (WEI) was calculated with software. The ELAPSS and PHASES scores were used to assess the growth and rupture risks of aneurysms. Spearman correlation analysis was used to observe the correlations between WEI and growth and rupture risks of aneurysm. Results Totally 248 asymptomatic unruptured intracranial saccular aneurysms were detected in 174 patients. HRMR VWI showed 78 aneurysms with AWE and 170 aneurysms without AWE. The size, location, shape, ELAPSS score, growth risk, PHASES score and 5-year rupture risk were all significant different between aneurysms with or without AWE (all P<0.05). Aneurysms with AWE had higher WEI than those without AWE (P<0.001). Spearman correlation analysis showed that WEI was positively correlated with 3- and 5-year growth risk (r_s=0.40, 0.40; both P<0.01) and 5-year rupture risk of aneurysm (r_s=0.24, P<0.01). Conclusion Higher WEI showed with HRMR VWI might predict worse instability of aneurysm.