Determinants of Gadolinium-Enhancement of the Aneurysm Wall in Unruptured Intracranial Aneurysms
Determinants of Gadolinium-Enhancement of the Aneurysm Wall in Unruptured Intracranial Aneurysms
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DOI：
10.1093/neuros/nyx487
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发表时间：
2018-10-01
期刊：
影响因子：
4.8
通讯作者：
Vergouwen, Mervyn D. I.
中科院分区：
文献类型：
--
作者：
Backes, Daan;Hendrikse, Jeroen;Vergouwen, Mervyn D. I.
背景技术背景：最近的研究表明，钆增强的动脉瘤壁可能反映动脉瘤壁炎症，这可能会增加动脉瘤生长或rupture.Objective的风险：以确定钆增强的患病率及其主要是小（1）未破裂动脉瘤患者的决定因素。通过泊松回归分析，我们计算了95%置信区间（CI）的粗风险比（RR）和调整后的风险比（RR），以评估钆增强的决定因素。结果：在25/79例患者（32%; 95% CI：21%-42%）和26/89例动脉瘤（29%; 95% CI：20%-39%）中观察到钆增强。以1.0-2.9 mm动脉瘤为参考，RR为4.6（95% CI：0.6-36.5）3.0 - 4.9 mm，9.4（95% CI：13-67.2）5.0 - 6.9 mm，14.8（95% CI：2.1-104.6）。以颈内动脉为参考，根据动脉瘤大小调整的RR为3.6大脑中动脉为3.0（95%CI：1.0-8.6）。RR为0.8（95% CI：0.4-1.8）使用乙酰水杨酸，0.9（95%CI：0.5-1.8）使用他汀类药物，1.4（95% CI：0.7-2.8）高血压，0.9（95%CI：0.4-1.8），从不吸烟者为0.9（95%CI：0.3-2.6），形状不规则者为1.4（95%CI：0.7-2.7）。由于动脉瘤大小是钆增强的最强决定因素，也是动脉瘤生长和破裂的既定预测因素，因此前瞻性研究需要研究钆增强是否可预测动脉瘤生长和破裂。
BACKGROUND: Recent studies suggest that gadolinium-enhancement of the aneurysm wall may reflect aneurysm wall inflammation, which might increase the risk of aneurysm growth or rupture.OBJECTIVE: To determine the prevalence of gadolinium-enhancement and its determinants in patients with predominantly small (1 unruptured aneurysm. With Poisson regression analysis, we calculated crude and adjusted risk ratios (RRs) with 95% confidence intervals (CI) to assess determinants of gadolinium enhancement. RESULTS: Gadolinium-enhancement was observed in 25/79 patients (32%; 95% CI: 21%42%) and 26/89 aneurysms (29%; 95% CI: 20%-39%). With aneurysms 1.0-2.9 mm as reference, RRs were 4.6 (95% CI: 0.6-36.5) for 3.0 to 4.9 mm, 9.4 (95% CI:13-67.2) for 5.0 to 6.9 mm, and 14.8 (95% CI: 2.1-104.6) for >7.0 mm. With internal carotid artery as reference, RRs adjusted for aneurysm size were 3.6 (95% CI: 1.1-11.4) for posterior communicating artery and 3.0 (95% CI:1.0-8.6) for middle cerebral artery. RRs were 0.8 (95% CI: 0.4-1.8) for acetylsalicylic acid use, 0.9 (95% CI: 0.5-1.8) for statin use,1.4 (95% CI: 0.7-2.8) for hypertension, 0.9 (95% CI: 0.4-1.8) for previous smoking, 0.9 (95% CI: 0.3-2.6) for never smoking, and 1.4 (95% CI: 0.7-2.7) for irregular aneurysm shape.CONCLUSION: Approximately one-third of patients had gadolinium-enhancement. Because aneurysm size is the strongest determinant of gadolinium-enhancement and also an established predictor for aneurysm growth and rupture, prospective studies with serial imaging need to investigate if gadolinium-enhancement predicts aneurysm growth and rupture.