Morphological Characteristics of Intracranial Aneurysms and Applicability of CT Angiography in Risk Assessment of Rupture
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摘要:
目的：探讨CT血管造影（CTA）在颅内动脉瘤破裂风险评估中的应用价值及形态学特征。方法：选取2018年10月至2021年10月蚌埠医学院第三附属医院颅内动脉瘤患者82例，所有研究对象均通过西门子64排128层螺旋CT及西门子数字减影血管造影（DSA）机实施CTA检查及DSA检查。统计分析本组患者瘤体破裂情况、不同瘤体破裂情况者形态学特征，并分析颅内动脉瘤瘤体破裂影响因素。结果：本组82例颈动脉患者瘤体破裂率为74.39％（61/82）、瘤体未破裂率为25.61％（21/82）；瘤体破裂者子囊数目（60.66％）、面积比、SR、AR、瘤体长度大于瘤体未破裂者，瘤体破裂者动脉瘤单发情况（91.80％）、动脉瘤分布位置与瘤体未破裂者比较无显著差异。Logistic回归分析证实，面积比、SR、AR、瘤体长度均是导致颅内动脉瘤瘤体破裂的重要危险因素。结论：通过CTA检查可明确颅内动脉瘤患者瘤体形态学特征，评估瘤体破裂风险。
Abstract:Objective: To explore the application value and morphological characteristics of CT angiography (CTA) in the risk assessment of intracranial aneurysm rupture. Method: We included 82 patients with intracranial aneurysms from the Third Affiliated Hospital of Bengbu Medical College from October 2018 to October 2021. All study participants underwent CTA and digital subtraction angiography (DSA) examinations using Siemens 64 row 128 slice spiral CT and Siemens DSA machines. Statistical analyses were conducted on the condition of tumor rupture. The morphological characteristics of different tumor rupture cases, and the factors influencing intracranial aneurysm rupture were analyzed. Result: The rupture rate of 82 carotid artery patients in this group was 74.39% (61/82), and the non-rupture rate of the tumor was 25.61% (21/82). The number of sub-capsules (60.66%), area ratio, Size ration (SR), Aspect ratio (AR) and length of the ruptured aneurysm were greater than that of the unruptured aneurysm. The ruptured and unruptured aneurysms did not differ significantly in the incidence of single aneurysm (91.80%) and the distribution of aneurysms. Logistic regression analysis confirmed that area ratio, SR, AR, and tumor length were important risk factors for intracranial aneurysm rupture. Conclusion: CTA examination can clarify the morphological characteristics of intracranial aneurysms and evaluate the risk of tumor rupture.
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图 2 男性，46岁，突发头晕、头痛伴恶心呕吐
注：（a）CT横轴位平扫提示蛛网膜下腔出血；（b）CTA重建VRT提示右侧颈内动脉C7段动脉瘤，进行瘤高、瘤颈、瘤深测量；（c）和（d）MIP图提示右侧颈内动脉C7段动脉瘤以及瘤颈处动脉瘤面积测量；（e）DSA证实右侧颈内动脉C7段动脉瘤并进行栓塞处理。
Figure 2. Male, 46 years old, Sudden dizziness, headache、nausea and vomiting
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图 3 男性，51岁，突发意识不清
注：（a）CT横轴位平扫提示蛛网膜下腔出血；（b）CTA重建VRT提示右侧颈内动脉C7段动脉瘤，进行瘤高、瘤颈、瘤深测量；（c）和（d）MIP图提示右侧颈内动脉C7段动脉瘤以及瘤颈处动脉瘤面积测量；（e）DSA证实右侧颈内动脉C7段动脉瘤。
Figure 3. Male, 51 years old, Sudden unconsciousness
表 1 不同瘤体破裂情况者形态学特征分析
Table 1 Morphological characteristics analysis of patients with different tumor rupture situations
形态学特征 组别 统计检验 瘤体破裂 瘤体未破裂 $\chi^2/t $ P 例数 61 21 － － 子囊数目n/％ 37（60.66） 5（23.81） 8.489 0.004 面积比 2.98±0.84 1.89±0.56 5.527 <0.001 SR 2.31±0.86 1.59±0.64 3.511 0.001 AR 1.71±0.72 1.30±0.59 2.349 0.021 瘤体长度/mm 6.11±2.13 4.49±1.64 3.172 0.002 动脉瘤单发n/％ 56（91.80） 20（95.24） 0.272 0.602 动脉瘤分布位置n/％ 大脑前动脉 7（11.48） 5（23.81） 1.902 0.168 大脑中动脉 12（19.67） 4（19.05） 0.004 0.950 前交通动脉 15（24.59） 3（14.29） 0.968 0.325 后交通动脉 20（32.79） 3（14.29） 2.650 0.104 后循环 7（11.48） 6（28.57） 3.423 0.064 
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表 2 颅内动脉瘤瘤体破裂影响因素分析
Table 2 Analysis of factors influencing intracranial aneurysm rupture
变量 β S.E. Wald $\chi^2 $ P OR 95％ CI 面积比 1.280 0.414 9.556 <0.001 3.596 1.892～6.834 SR 1.215 0.406 8.954 <0.001 3.370 1.781～6.376 AR 1.597 0.613 6.790 <0.001 4.940 3.067～7.957 瘤体长度 1.534 0.571 7.216 <0.001 4.636 2.564～8.382
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