基于CT血管成像的颅内动脉瘤破裂风险预测模型的构建  

CT angiography-based model construction for predicting the rupture risk of intracranial aneurysms

作　　者：颜格 卞益同 刘哲[1] 屈婷婷[1] 谢万福[2] 赵婷婷[1] 杨健[1] 金超[1] YAN Ge;BIAN Yitong;LIU Zhe;QU Tingting;XIE Wanfu;ZHAO Tingting;YANG Jian;JIN Chao(Department of Radiology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Neurosurgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院医学影像科,陕西西安710061 [2]西安交通大学第一附属医院神经外科,陕西西安710061

出　　处：《实用放射学杂志》2021年第12期1951-1954,1984,共5页Journal of Practical Radiology

摘　　要：目的探讨基于CT血管成像(CTA)的颅内动脉瘤破裂的危险因素并建立动脉瘤破裂预测模型。方法回顾性纳入有完整CTA影像和临床资料(含动脉瘤是否破裂随访结果)的112例颅内动脉瘤患者,共136个颅内动脉瘤(破裂80个,未破裂56个)作为研究对象;采用单因素方法分析破裂动脉瘤与未破裂动脉瘤的临床和影像学特征,包括动脉瘤瘤长(AS)、瘤垂直高(AD)、瘤颈宽(NW)、载瘤血管直径(PD)、入流角度、高宽比(AR)、尺寸比(SR);采用多元Logistic回归分析颅内动脉瘤破裂的危险因素,并通过诺模图建立动脉瘤破裂的预测模型。结果单因素与多元Logistic回归结果表明,动脉瘤AS[优势比(OR)=1.759,P=0.018]、SR(OR=1.914,P=0.014)、AR(OR=2.585,P=0.035)、是否位于分叉处(OR=2.216,P=0.050)及入流角度(OR=1.737,P=0.048)是颅内动脉瘤破裂的独立危险因素;诺模图构建的预测模型准确率为78.5%,灵敏度为81.7%,特异度为72.8%。结论动脉瘤AS、AR、SR、位于分叉处及入流角度是动脉瘤破裂的危险因素,构建的预测模型可辅助临床进行动脉瘤破裂预测。Objective To explore the risk factors associated with the rupture of intracranial aneurysms and develop a model for predicting the rupture risk by using computed tomography angiography(CTA).Methods 112 patients with intracranial aneurysms who had complete CTA and clinical data(including the ruptured or unruptured follow-up outcome)were retrospectively enrolled,and 136 intracranial aneurysms(ruptured/unruptured,80/56)were finally collected.Univariate analysis was used to investigate the clinical and imaging features[aneurysm size(AS),aneurysm depth(AD),neck width(NW),parent artery diameter(PD),inflow angle,aspect ratio(AR),size ratio(SR)]of ruptured and unruptured aneurysms.Multivariate Logistic regression was then used to identify the risk factors associated with aneurysms rupture and develop a nomogram model for predicting the rupture risk.Results Univariate and multivariate analysis results indicated that AS[odds ratio(OR)=1.759,P=0.018],SR(OR=1.914,P=0.014),AR(OR=2.585,P=0.035),locating at bifurcate(OR=2.216,P=0.050)and inflow angle(OR=1.737,P=0.048)were independent risk factors associated with rupture of intracranial aneurysms;nomogram model showed good prediction performance with accuracy of 78.5%,sensitivity of 81.7%and specificity of 72.8%.Conclusion The AS,AR,SR,locating at bifurcate or sidewall and inflow angle are independent risk factors associated with rupture of intracranial aneurysms and the nomogram incorporating the above factors presented good prediction performance.

关 键 词：颅内动脉瘤 破裂风险 计算机体层成像 血管造影术 预测模型 

分 类 号：R739.41[医药卫生—肿瘤] R814.42[医药卫生—临床医学]