颅内动脉瘤破裂风险因素预测:基于CT血管成像形态学联合临床因子和血液炎症指标  

Risk factor prediction of intracranial aneurysm rupture:a multimodal analysis integrating CTA-derived morphology,clinical characteristics and hematological inflammatory markers

作　　者：王玙璠 李裕国 顾长青 时凡 仝贺 李松 马宜传 WANG Yufan;LI Yuguo;GU Changqing;SHI Fan;TONG He;LI Song;MA Yichuan(Department of Radiology,the Second Affiliated Hospital of Bengbu Medical University,Bengbu 233017,China;Department of Radiology,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,China;Department of Radiology,Bengbu First People's Hospital,Bengbu 233000,China;Department of Pathology,Bengbu First People's Hospital,Bengbu 233000,China)

机构地区：[1]蚌埠医科大学第二附属医院放射科,安徽蚌埠233017 [2]蚌埠医科大学第一附属医院放射科,安徽蚌埠233004 [3]蚌埠市第一人民医院放射科,安徽蚌埠233000 [4]蚌埠市第一人民医院病理科,安徽蚌埠233000

出　　处：《分子影像学杂志》2025年第4期412-418,共7页Journal of Molecular Imaging

基　　金：安徽省临床医学研究转化专项项目(202304295107020072)。

摘　　要：目的基于CT血管成像(CTA)的形态学参数、患者的临床因子和血液炎症指标,对颅内动脉瘤(IA)的破裂风险因素进行分析。方法回顾性分析2022年11月~2024年9月于蚌埠医科大学第二附属医院就诊的176例IA患者,根据是否存在蛛网膜下腔出血分为未破裂组(n=72)和破裂组(n=104)。收集两组的临床资料、血液炎症指标数据和CTA影像的瘤体形态学参数进行对比,通过单因素、多因素Logistic回归分析得出IA破裂的风险因素,并且通过分析ROC曲线和AUC对风险因素进行诊断效能的评估。结果IA的形态不规则(OR=3.079,95%CI:1.030~9.200,P=0.044)、存在子囊(OR=3.271,95%CI:1.109~9.650,P=0.032)、尺寸比(OR=2.117,95%CI:1.074~4.170,P=0.030)、长宽比(OR=7.189,95%CI:1.242~41.619,P=0.028)、全身炎症反应指数(OR=1.500,95%CI:1.242~1.810,P<0.001)是独立破裂风险因素,其AUC值分别为0.77、0.75、0.67、0.75、0.93。结论基于CTA形态学参数联合临床因子与血液炎症指标数据分析发现,IA的形态不规则、存在子囊、高尺寸比、高长宽比及高全身炎症反应指数均是动脉瘤破裂的高危因素,对其破裂风险的预测有重要意义。Objective To analyze the risk factors for intracranial aneurysm(IA)rupture based on morphological parameters from computed tomography angiography(CTA),clinical characteristics of patients,and hematological inflammatory indicators.Methods A retrospective analysis was conducted on 176 IA patients treated at the Second Affiliated Hospital of Bengbu Medical University from November 2022 to September 2024.Based on the presence or absence of subarachnoid hemorrhage,patients were categorized into an unruptured group(n=72)and a ruptured group(n=104).Clinical data,hematological inflammatory indicators,and CTA-derived aneurysmal morphological parameters were compared between the two groups.Univariate and multivariate logistic regression analyses were employed to identify risk factors for IA rupture.Additionally,ROC curves and area under the curve(AUC)analyses were performed to evaluate the diagnostic efficacy of these risk factors.Results Irregular morphology(OR=3.079,95%CI:1.030-9.200,P=0.044),presence of daughter sacs(OR=3.271,95%CI:1.109-9.650,P=0.032),elevated size ratio(OR=2.117,95%CI:1.074-4.170,P=0.030),increased aspect ratio(OR=7.189,95%CI:1.242-41.619,P=0.028),and elevated systemic inflammatory response index(OR=1.500,95%CI:1.242-1.810,P<0.001)were identified as independent risk factors for IA rupture,with AUC values of 0.77,0.75,0.67,0.75 and 0.93,respectively.Conclusion Analysis based on CTA morphological parameters combined with clinical factors and blood inflammation indicators reveals that IAs with irregular morphology,presence of daughter sacs,high size ratio,high aspect ratio,and elevated systemic inflammatory response index are all high-risk factors for aneurysm rupture.These factors hold immense importance in accurately predicting the risk of aneurysm rupture.

关 键 词：颅内动脉瘤 CT血管成像 动脉瘤破裂 蛛网膜下腔出血 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]