大脑中动脉分叉处形态学参数对动脉瘤发生的预测价值  

Predictive value of morphological parameters of bifurcation of middle cerebral artery on aneurysm occurrence

作　　者：范文龙 宫希军[1] 王龙胜[1] 汪永康 陈露 申动[2] FAN Wenlong;GONG Xijun;WANG Longsheng;WANG Yongkang;CHEN Lu;SHEN Dong(Department of Radiology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Southern Medical University,Guangzho 510515,China)

机构地区：[1]安徽医科大学第二附属医院放射科,安徽合肥230601 [2]南方医科大学,广东广州510515

出　　处：《实用放射学杂志》2022年第6期871-875,共5页Journal of Practical Radiology

基　　金：安徽医科大学科学研究基金资助项目(2020xkj193);安徽医科大学第二附属医院临床培育计划项目(2021LCZD007)。

摘　　要：目的探讨大脑中动脉(MCA)分叉形态学参数对动脉瘤的预测价值.方法回顾性分析60例MCA分叉动脉瘤患者,并选择60例性别、年龄相近的行CT血管成像(CTA)检查无动脉瘤患者作为对照组.比较患者组同侧MCA分支(载瘤侧)、对侧MCA分支(无瘤侧)的形态学参数和对照组形态学参数的差异.参数包括颈内动脉(ICA)末端直径、分叉处主干直径(D1)、较粗支直径(D2)、较细支直径(D3)、ICA/D1、D1/D2、D1/D3、D2/D3、分叉角(γ3)、侧角γ1/侧角γ2.在对上述定量参数进行分析后,得到有统计学意义的受试者工作特征(ROC)曲线,并对其进行预测价值研究.结果MCA分叉动脉瘤在侧角小、直径小的分叉血管中更常见,患者组载瘤侧、无瘤侧与对照组的γ3及γ1/γ2差异有统计学意义(P<0.001),载瘤侧与对侧分叉处的血管直径和直径比值无显著差异(P>0.05).ROC曲线显示,γ3、γ1/γ2和D3比其他参数能更好地预测MCA分叉动脉瘤,并且γ3的预测价值最高.当γ3=129.8°时,预测的最大敏感度和特异度分别为76.7%和96.7%.结论在MCA分叉处,动脉瘤多发生在侧角小及直径小的分叉血管中,γ3=129.8°、γ1/γ2=1.28、D3=1.63 mm是MCA分叉处动脉瘤发生的危险临界值.Objective To investigate the predictive value of morphological parameters of middle cerebral artery(MCA)bifurcation for aneurysm.Methods Sixty patients with MCA bifurcation aneurysms were analyzed retrospectively.Besides,60 patients with aneurysm free computed tomography angiography(CTA)of similar sex and age were selected as the control group.The morphological parameters of the ipsilateral MCA branch(with aneurysm)and contralateral MCA branch(without aneurysm)of the patient group and morphological parameters differences of the control group were compared.The parameters included the diameter of the end of the internal carotid artery(ICA),the diameter of the main bifurcation(D1),the diameter of the coarser branch(D2),the diameter of the finer branch(D3),ICA/D1,D1/D2,D1/D3,D2/D3,bifurcation angle(γ3),and lateral angle γ1/lateral angle γ2.After the analysis of the above quantitative parameters,the receiver operating characteristic(ROC)curve with statistical significance was obtained,and its predictive value was investigated.Results MCA bifurcation aneurysm occured more frequently in the bifurcation vessel with a small lateral angle and small diameter.There were significant differences in the γ3 and γ1/γ2 between the side with aneurysm in the patient group,the side without aneurysm in the patient group,and the control group(P<0.001).There was no significant difference in vessel diameter and diameter ratio between the side with aneurysm and the contralateral bifurcation(P>0.05).The ROC curve showed that γ3,γ1/γ2 and D3 could better predict MCA bifurcation aneurysm than other parameters,and the predictive value ofγ3 was the highest.When γ3=129.8,the maximum sensitivity and specificity of the predication were 76.7% and 96.7%.Conclusion At the MCA bifurcation,aneurysm occurs more frequently in the bifurcation vessel with a small lateral angle and small diameter,the γ3=129.8,γ1/γ2=1.28,D3=1.63 mm.are the critical values of the occurrence of MCA bifurcation aneurysm.

关 键 词：颅内动脉瘤 大脑中动脉 形态学 血流动力学 

分 类 号：R739.41[医药卫生—肿瘤] R743[医药卫生—临床医学] R814.43