复合型形态学特征联合流体力学对肾下型腹主动脉瘤破裂风险的评估  

Efficacy of geometric characteristics and hemodynamics for evaluating the risk of abdominal aortic aneurysm rupture

作　　者：徐健[1] 陈凯 王相权[1] 肖华伟[1] 王铃 吴鹏 XU Jian;CHEN Kai;WANG Xiangquan;XIAO Huawei;WANG Ling;WU Peng(Department of Radiology,Zhejiang Provincial People's Hospital,Zhejiang 310014,China)

机构地区：[1]浙江省人民医院放射科,浙江杭州310014 [2]苏州大学机电工程学院,江苏苏州215021 [3]东南大学机械工程学院、江苏省微纳生物医疗器械设计与制造重点实验室,江苏南京211189

出　　处：《影像诊断与介入放射学》2024年第2期102-107,共6页Diagnostic Imaging & Interventional Radiology

基　　金：浙江省卫生健康科技计划项目(2021KY474)。

摘　　要：目的探讨复合型几何形态学特征对腹主动脉瘤(AAA)破裂风险的影响,并进行流体力学分析。方法回顾性收集2019年6月—2023年8月行CTA检查的AAA未破裂患者25例(完整组)和同期检查进行性别和年龄1∶1配比的AAA破裂患者25例(破裂组)。比较两组患者之间AAA的形态学特征,筛选AAA破裂风险的影响因素,并进行流体力学分析。结果破裂组和完整组的瘤体最大直径(D_(max))、瘤颈直径(D_(neck))、瘤体最大直径/健康主动脉直径(D_(max)/DAO)、瘤体最大直径/瘤颈直径(D_(max)/D_(neck))、标准化动脉瘤范围(L_(nor))分别为(5.92±1.50)cm和(3.67±0.68)cm、(2.38±0.50)cm和(2.06±0.03)cm、(2.54±0.67)和(1.56±0.34)、(2.53±0.62)和(1.81±0.38)、(22.73±11.08)和(10.78±4.59);破裂组的形态学指标量值均高于完整组,其差异均具有统计学意义(t=6.947、2.563、6.567、4.952、4.982,P均<0.05)。其中D_(max)和D_(max)/DAO是AAA破裂风险的独立影响因素(OR分别为1.824、4.039,95%CI分别为1.459~6.251和3.261~9.155,P<0.05)。包含复合型形态学特征的多变量新模型对破裂风险分类的准确性高于仅包含D_(max)的常规模型(94%比88%)。破裂组和完整组AAA分别表现为Ⅲ型和Ⅱ型血流模式,并且破裂组AAA的低壁剪切力面积大于完整动脉瘤(73.9 cm^(2)比67.8 cm^(2))。结论结合形态学特征D_(max)、D_(max)/DAO和流体力学的血流模式和低壁剪切力面积有助于评估AAA的破裂风险。Objective To investigate the efficacy of geometric characteristics and hemodynamics for evaluating the risk of abdominal aortic aneurysm(AAA)rupture.Methods Twenty-five patients with intact AAAs(iAAA group)and 25 patients with ruptured AAAs(rAAA group)from June 2019 to August 2023 were matched 1∶1 with covariates of gender and age.Geometric characteristics,risk factors for rupture,and hemodynamics of the AAAs were analyzed.Results The maximal AAA diameter[D_(max):(5.92±1.50)cm,t=6.947,P<0.05],diameter of AAA neck[D_(neck):(2.38±0.50)cm,t=2.563,P<0.05],the ratio of D_(max) to diameter of normal aorta(D_(max)/DAO:2.54±0.67,t=6.567,P<0.05),D_(max)/D_(neck)(2.53±0.62,t=6.567,P<0.05),and normalized length of AAA(L_(nor):22.73±11.08,t=4.982,P<0.05)in rAAA group were significantly greater than that of iAAA group[(3.67±0.68)cm,(2.06±0.03)cm,1.56±0.34,1.81±0.38,10.78±4.59].Multivariate logistic analysis showed that D_(max)(OR=1.824,95%CI:1.459-6.251)and D_(max)/DAO(OR=4.039,95%CI:3.261-9.155)were significant risk predictors for AAA rupture.The multivariate model using integrated geometric features had higher accuracy(94%)than conventional D_(max)(88%)for predicting the risk of AAA rupture.rAAA had typeⅢand iAAA had typeⅡblood flow patterns.rAAA had greater area of low wall shear stress(73.9 cm^(2))than iAAA(67.8 cm^(2)).Conclusion Evaluation of AAA rupture risk is improved by geometric characteristics of D_(max) and D_(max)/DAO combined with blood flow pattern and area of low wall shear stress.

关 键 词：体层摄影术 X线计算机 CT血管造影术 腹主动脉瘤 壁剪切力 

分 类 号：R814.42[医药卫生—影像医学与核医学] R543.1[医药卫生—放射医学]