基于计算机辅助半自动测量的颅内动脉瘤形态学参数与动脉瘤破裂相关性分析  

Morphological risk factors for intracranial aneurysm rupture based on computer-assisted semi-automated measurements

作　　者：王雅栋[1] 耿介文 胡鹏[2] 何川[2] 张鸿祺[2] Wang Yadong;Geng Jiewen;Hu Peng;He Chuan;Zhang Hongqi(Department of Neurosurgery,Weihai Municipal Hospital,Weihai,Shandong 264299,China)

机构地区：[1]山东省威海市立医院神经外科,264299 [2]首都医科大学宣武医院神经外科

出　　处：《中国脑血管病杂志》2024年第5期289-296,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：北京市科学技术委员会首都临床诊疗技术研究及转化应用(Z201100005520021);北京市卫生健康科技成果和适宜技术推广项目(BHTPP202018);北京市博士后资助项目(2023-ZZ-009)。

摘　　要：目的评估计算机辅助半自动测量的动脉瘤三维形态学参数与动脉瘤破裂风险的相关性。方法回顾性连续纳入2019年10月至2022年10月于首都医科大学宣武医院神经外科收治的破裂多发动脉瘤患者。采用计算机辅助半自动测量方法测量入组患者动脉瘤形态学参数(包括动脉瘤直径、最大径、宽度、瘤颈宽度、体积、入射角、载瘤动脉直径、表面积、波动指数、非球形指数),计算动脉瘤长宽比、宽颈比、纵横比和尺寸比,并记录动脉瘤位置信息。将多发动脉瘤中破裂责任动脉瘤纳入破裂组,其余动脉瘤纳入未破裂组。采用单因素分析及多因素二元Logistic分析评价破裂组和未破裂组形态学参数及动脉瘤位置信息的差异。结果56例破裂多发动脉瘤患者共126个动脉瘤纳入分析。在形态学方面,直径>5 mm[51.8%(29/56)比15.7%(11/70),P<0.01]、最大径>6 mm[57.1%(32/56)比25.7%(18/70),P<0.01]、入射角>107°[57.1%(32/56)比35.7%(25/70),P=0.016]、宽颈比>1.1[50.0%(28/56)比30.0%(21/70),P=0.022]、纵横比>1.1[46.4%(26/56)比25.7%(18/70),P=0.015]和尺寸比>1.9[57.1%(32/56)比10.0%(7/70),P<0.01]在破裂组与未破裂组之间差异均有统计学意义;在动脉瘤位置方面,破裂组动脉瘤主要位于颈内动脉后交通段[39.3%(22/56)]和大脑中动脉[23.2%(13/56)],而非破裂组动脉瘤主要位于大脑中动脉[28.6%(20/70)]和颈内动脉非后交通段[27.1%(19/70)],两组动脉瘤位置分布差异有统计学意义(P=0.003)。多因素Logistic回归分析结果表明,尺寸比>1.9为动脉瘤破裂的独立危险因素(OR=11.62,95%CI:2.40~56.15;P=0.002)。在动脉瘤位置方面,颈内动脉后交通段动脉瘤的破裂风险高于颈内动脉非后交通段动脉瘤(OR=19.25,95%CI:2.19~169.51;P=0.008)。结论对于多发性颅内动脉瘤,动脉瘤的三维形态学参数中尺寸比>1.9是动脉瘤破裂的独立危险因素,颈内动脉后交通段动脉瘤的破裂风险明显高于颈内动Objective To evaluate the correlation between 3D morphological parameters of aneurysms based on the computer-assisted semi-automated measurement and the risk of aneurysm rupture.Methods From October 2019 to October 2022,patients with ruptured multiple aneurysms admitted to the Department of Neurosurgery of Xuanwu Hospital,Capital Medical University were retrospectively included.Aneurysmal morphological parameters(including aneurysmal diameter,maximum diameter,width,neck width,volume,flow angle,parental artery diameter,surface area,wave index and non-spherical index)were measured by computer-assisted semi-automated measurement methods.The length-to-width ratio,wide-to-neck ratio,aspect ratio and size ratio were calculated,and the aneurysm location information was recorded.The ruptured aneurysms in multiple aneurysms were included in the ruptured group,and the remaining aneurysms were included in the unruptured group.Univariable analysis and binary Logistic analysis were used to evaluate the differences in morphological parameters and location information between the ruptured and unruptured groups.Results All 56 patients with multiple ruptured aneurysms and a total of 126 aneurysms were included in the group for analysis.Concerning morphology,including diameter>5 mm(51.8%[29/56]vs.15.7%[11/70],P<0.01),maximum diameter>6 mm(57.1%[32/56]vs.25.7%[18/70],P<0.01),flow angle>107°(57.1%[32/56]vs.35.7%[25/70],P=0.016),wide-to-neck ratio>1.1(50.0%[28/56]vs.30.0%[21/70],P=0.022),aspect ratio>1.1(46.4%[26/56]vs.25.7%[18/70],P=0.015)and size ratio>1.9(57.1%[32/56]vs.10.0%[7/70],P<0.01),there was significant difference between the ruptured and unruptured group;Concerning locations,aneurysms are mainly located in the posterior communicating segment of the internal carotid artery(39.3%[22/56])and the middle cerebral artery(23.2%[13/56])in ruptured group,while in the middle cerebral artery(28.6%[20/70])and the non-posterior communicating segment of internal carotid artery(27.1%[19/70])in unruptured group,and there was significant

关 键 词：颅内动脉瘤 计算机辅助半自动测量 形态学参数 位置 破裂动脉瘤 

分 类 号：R743[医药卫生—神经病学与精神病学]