摘要
目的探讨导致大脑中动脉(MCA)小动脉瘤破裂的动脉瘤形态特征。方法回顾性分析2010年1月至2019年12月温州医科大学附属第一医院399例患者的426个MCA小动脉瘤。将动脉瘤<7 mm定义为小动脉瘤。对CTA图像进行重建和测量来获得动脉瘤形态特征。对动脉瘤形态特征进行单因素及多因素Logistic回归分析,得到与MCA小动脉瘤破裂相关的动脉瘤形态特征。采用ROC曲线评估动脉瘤形态学特征预测MCA小动脉瘤破裂的效能。结果在426个MCA小动脉瘤中,破裂动脉瘤为223个(52.3%)。单因素结果显示,破裂动脉瘤组拥有较大动脉瘤、纵横比值、尺寸比值、宽颈比值和较小的瘤颈、动脉瘤角度和载瘤血管角度。另外破裂组动脉瘤更容易为不规则及子瘤形成,并且也与动脉瘤朝向相关。多因素Logistic回归结果显示:较大的动脉瘤、较大纵横比值、较小的瘤颈和子瘤形成是MCA小动脉瘤破裂的危险因素[OR(95%CI)=1.893(1.362~2.631)、2.866(1.077~7.628)、0.437(0.281~0.679)、3.610(1.598~8.158),均P<0.05]。动脉瘤形态学特征预测模型的AUC值为0.788(95%CI=0.746~0.831),敏感度为0.740,特异度为0.719。结论单纯的动脉瘤形态学特征模型能较好地预测MCA小动脉瘤的破裂。动脉瘤大小、纵横比值、瘤颈及子瘤是MCA小动脉瘤破裂的影响因素。
Objective To investigate the aneurysm morphological characteristics leading to the rupture of the small middle cerebral artery(MCA)microaneurysm.Methods A total of 426 MCA microaneurysms from 399 patients,who admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2010 to December 2019,were retrospectively analyzed.Microaneurysm was defined as the aneurysm with size<7 mm.CTA images were reconstructed and measured to obtain aneurysm morphological characteristics.Univariate and multivariate Logistic regression analyses were adopted to investigate the morphological characteristics related to the rupture of MCA microaneurysm.The receiver operating characteristic(ROC)curve was used to evaluate the predictive performance of aneurysm morphological characteristics on the rupture of small MCA aneurysm.Results Two hundren and twenty-three out of 426(52.3%)MCA microaneurysms were ruptured.Univariate analysis revealed that compared with the unruptured group,aneurysms in the ruptured group were larger in size,aspect ratio,size ratio and wide-neck ratio,while smaller in neoplasia neck,aneurysmal angle,and parentvessel angle.In addition,aneurysms in the ruptured group was more likely to be irregular and with daughter tumor formation.Aneurysm orientation was also related to the rupture.Multivariate Logistic regression revealed that larger aneurysm size larger,aspect ratio value,smaller neck size and daughter tumor formation were risk factors for the rupture of small MCA aneurysm[OR(95%CI)=1.893(1.362-2.631),2.866(1.077-7.628),0.437(0.281-0.679),3.610(1.598-8.158);P<0.05)].The AUC value,sensitivity,and specificity of the morphological-characteristics-based prediction model were 0.788(95%CI=0.746-0.831), 0.740 and 0.719, respectively. Conclusion This simple morphological model can predict the rupture of MCA microaneurysm well. Aneurysm size, aspect ratio value, neck size and daughter tumor were the independent risk factors for the rupture of MCA microaneurysm.
作者
郭献忠
周甲丰
李琼
林博丽
夏能志
王豪
郑葵葵
贾秀芬
杨运俊
陈勇春
Guo Xianzhong;Zhou Jiafeng;Li Qiong;Lin Boli;Xia Nengzhi;Wang Hao;Zheng Kuikui;Jia Xiufen;Yang Yunjun;Chen Yongchun(Imaging Department,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of Radiology,Wenzhou Central People's Hospital,Wenzhou 325000,China)
出处
《心脑血管病防治》
2023年第7期29-31,36,共4页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
基金
温州市基础性医疗卫生科技项目(Y2020164)。
关键词
大脑中动脉
动脉瘤
破裂
动脉瘤形态
Middle cerebral artery
Aneurysm
Rupture
Morphology of aneurysm
