双干型大脑中动脉分叉部动脉瘤形成与分叉部几何形态的CT血管成像  

Formation of bifurcation aneurysms of double-trunk middle cerebral artery(MCA) and CT angiography of bifurcation geometry

作　　者：梁梅 陈锦灿[1] 夏广明[1] LIANG Mei;CHEN Jincan;XIA Guangming(Department of Photography and Imaging,the First People's Hospital of Zhaoqing 526000,Guangdong,China)

机构地区：[1]广东省肇庆市第一人民医院影学影像科

出　　处：《包头医学院学报》2019年第9期24-26,共3页Journal of Baotou Medical College

摘　　要：目的:探讨双干型大脑中动脉(Middle cerebral artery,MCA)分叉部动脉瘤发生与MCA分叉几何形态的关系。方法:选取32例双干型MCA分叉部动脉瘤患者,患者入院就诊时间为2017年8月至2018年8月,同时收集30例同期行头部CT血管成像(CT angiography,CTA)检查的无动脉瘤患者,入选者均采用Philips Ingenuity Core-128层CT检查,预扫后连接高压注射器,注入15 mL生理盐水和65 mL碘普罗胺,将扫描后的数据传至Philips三维工作站,三维后处理采用最大密度投影(Maximum intensity projection,MIP)和血管容积再现(Volume rendering,VR)图像,测量较细分支与主干夹角(γ2)、较粗分支与主干夹角(γ1)、分支管径、分叉角(γ3)、分叉部血管管径,最后计算分支管径比和两分支夹角比,以数字减影血管造影结果为标准,绘制各项血管形态学参数诊断效能的ROC曲线,确定Cut-off值,对诊断效能进行评价。结果:动脉瘤组分叉部血管管径、γ1、γ2均较对照组要小(P<0.05),γ3较对照组要大(P<0.05);两组患者的血管两分支夹角及分支管径比较,差异无明显统计学意义(P>0.05);当γ1<101°、γ2<91°、γ3>105°、分叉部血管管径<1.95 mm时,动脉瘤发生风险相对较高,分叉部管径、γ2、γ3曲线下面积均>0.7,诊断价值较高,而γ1曲线下面积<0.7,诊断价值相对较低。结论:MCA分叉部几何形态参数与双干型MCA分叉部动脉瘤形成有一定关联,分叉部动脉瘤患者分叉部血管管径、γ1、γ2减小,γ3增大,通过分析以上参数,能帮助筛选动脉瘤高危人群,值得在临床上推广应用。Objective:To investigate the relationship between the bifurcation geometry and the occurrence of bifurcation aneurysms of double-trunk middle cerebral artery(MCA).Methods:32 patients with bifurcated aneurysms of double-trunk MCA were enrolled from August 2017 to August 2018.Meanwhile,30 patients without aneurysms who underwent head CT angiography(CTA)examination at the same time in our hospital were collected.All patients were examined by Philips Ingenuity Core 128-slice CT.After pre-scan,connected with a high-pressure syringe and injected with 15ml normal saline and 65ml iopromethamine,and scanned.Then the data were transmitted to Philips three-dimensional workstation.The maximum density projection(MIP)and vascular volume rendering(VR)images were used in the three-dimensional post-processing.The angle between subdivision and trunk(γ2),the angle between thicker branch and trunk(γ1),branch diameter,bifurcation angle(γ3),bifurcation diameter were measured.Finally,the ratio of branch diameter to bifurcation angle was calculated to make digital subtraction angiography.The results were“gold standard”.The ROC curves of diagnostic efficacy of various vascular morphological parameters were drawn,Cut-off values were determined,and the diagnostic efficacy was evaluated.Results:The bifurcation vessel diameter,γ1 andγ2 of aneurysm group were significantly smaller than those of control group,andγ3 was significantly larger than that of control group(P<0.05).There was no significant difference in the angle between the two branches and the ratio of branch diameter between the two groups(P<0.05).Whenγ1<101o,γ2<91,γ3>105°and bifurcation vessel diameter<1.95 mm,the risk of aneurysm was relatively high.The area under bifurcation vessel diameter,γ2 andγ3 curve were>0.7,which had higher diagnostic value,while the area underγ1 curve was less than 0.7,and the diagnostic value was relatively low.Conclusion:The geometric parameters of bifurcation of MCA are related to the formation of bifurcation aneurysms of double-trunk

关 键 词：形态 动脉瘤 双干型 大脑中动脉 头部CT血管成像 

分 类 号：R74[医药卫生—神经病学与精神病学]