四维CT血管成像对颅内小动脉瘤破裂风险因素的分析研究  

Analysis of risk factors for the rupture of small intracranial aneurysms by four-dimensional CT angiography

作　　者：顾艳[1] 张永刚[1] 骆孟[1] 张洪伟[1] 刘希光[2] 苗重昌[1] Gu Yan;Zhang Yonggang;Luo Meng;Zhang Hongwei;Liu Xiguang;Miao Chongchang

机构地区：[1]江苏省连云港市第一人民医院影像科,222002 [2]江苏省连云港市第一人民医院神经外科,222002

出　　处：《中华放射学杂志》2019年第6期480-484,共5页Chinese Journal of Radiology

基　　金：江苏省卫生健康委科研课题面上项目(H2018091);连云港市卫生计生科技面上项目(201801).

摘　　要：目的采用心电监控四维CT血管成像(4D-CTA)分析颅内小动脉瘤破裂的风险预测因素。方法回顾性分析2014年5月至2017年5月间在连云港市第一人民医院行心电监控4D-CTA检查的、<5 mm的共118例患者。根据动脉瘤有无破裂,分为破裂组(72例)和未破裂组(46例)。将所有患者扫描后的原始数据进行重建,得出一个心动周期内的时间间隔均为5%的20组数据包,经工作站三维软件处理后,得到20组图像及动态图。将同一部位连续3幅及以上图像发现小泡状或小尖状凸起,判定该凸起为搏动点。并将两组动脉瘤的形态特征和临床特征先进行单因素分析,然后将有意义的指标进行logistic回归分析,并用ROC曲线计算最佳诊断界值。结果单因素分析显示,破裂组和未破裂组患者性别、吸烟史、生长在血管分叉点、出现搏动点、瘤颈比(AR)、瘤高与载瘤动脉管径之比(SR)的差异均有统计学意义(P<0.05),而年龄、高血压、2型糖尿病、家族史、多发动脉瘤史、饮酒史、部位、大小、瘤颈、瘤高的差异无统计学意义(P>0.05)。多因素回归分析显示,出现搏动点(优势比=8.843,95%可信区间:2.800~27.925)和较大的SR值(优势比=4.484,95%可信区间:1.094~18.385)对动脉瘤的破裂风险有独立预测价值;当SR值>1.65时,ROC曲线下面积为0.832,诊断小动脉瘤破裂风险的敏感度为76%,特异度为70%。结论出现搏动点和SR值>1.65是颅内<5 mm的动脉瘤破裂的独立预测指标。Objective Electrocardiographic (ECG) gated 4-dimensional CT angiography (4D-CTA) was performed to analyze the morphological characteristic differences between ruptured and unruptured intracranial aneurysms less than 5 mm to predict the rupture risk of small intracranial aneurysms. MethodsA total of 118 patients with intracranial aneurysms less than 5 mm who underwent 4D-CTA examinations in our hospital from May 2014 to May 2017 were retrospectively analyzed. The whole study population was divided into ruptured group and unruptured group. Seventy-two patients were in the ruptured group and 46 patients were in the unruptured group. Original scanning data were reconstructed to produce 20 data sets of cardiac cycles with 5% time intervals. In addition, 20 groups of images and dynamic graphs were generated using three-dimensional software. We concluded the convex was point of impulse if small bubble or small pointed convex could be found in continuous three or more images at the same location. The morphological characteristics and clinical features of the two groups of aneurysms were firstly analyzed by univariate analysis, and then the meaningful indicators were analyzed by logistic regression, and the optimal diagnostic cutoff values were calculated using ROC curves. ResultsUnivariate analysis showed that women, smoking history, location of aneurysm at the bifurcation, pulsation point, aspect ratio (AR) and size ratio (SR) were statistically significant different between the two groups of small aneurysms (P<0.05), but age, hypertension, type 2 diabetes, family history, history of multiple aneurysms, history of drinking, location, size, neck and tumor height had no significant differences between the two groups (P>0.05). Multivariate regression analysis showed that pulsation point (odds ratio=8.843, 95% confidence interval: 2.800-27.925) and large SR value (odds ratio=4.484, 95% confidence interval: 1.094-18.385) were independent risk factors for the aneurismal rupture. When the SR value was greater than 1.65, the ar

关 键 词：体层摄影术 X线计算机 颅内动脉瘤 破裂 

分 类 号：R743[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]