Wall Enhancement, Hemodynamics, and Morphology in Unruptured Intracranial Aneurysms with High Rupture Risk
Wall Enhancement, Hemodynamics, and Morphology in Unruptured Intracranial Aneurysms with High Rupture Risk
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具有高破裂风险的未破裂颅内动脉瘤的壁增强、血流动力学和形态学
DOI：
10.1007/s12975-020-00782-4
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发表时间：
2020-10-01
影响因子：
6.9
通讯作者：
Liu, Jianmin
中科院分区：
文献类型：
--
作者：
Lv, Nan;Karmonik, Christof;Liu, Jianmin
本研究的目的是探讨血管壁 MRI 上的形态、血流动力学和动脉瘤壁增强 (AWE) 之间的关系及其在颅内动脉瘤破裂中的潜在作用。回顾性招募了 57 名患有 65 个未破裂颅内动脉瘤的患者（22 名男性和 35 名女性；平均年龄 58.4 岁）。血管壁 MRI 图像经过检查并区分为无 (NAWE)、部分 (PAWE) 和环周 (CAWE) 壁增强。计算几何和计算流体动力学用于计算形态和血液动力学参数。计算每个病例的阶段评分以估计其破裂风险。采用单变量和多变量逻辑回归分析来研究形态-血流动力学模式与 AWE 之间的关系及其与破裂风险的关联。 AWE 存在于 26 个（40.0%）病变中，其中 14 个（21.5%）PAWE 和 12 个（18.5%）CAWE。动脉瘤大小（优势比 = 7.46，95%置信区间 = 1.56–35.77，p= 0.012），大小比（优势比 = 12.90，95%置信区间 = 2.28–72.97，p= 0.004），以及归一化壁剪应力（优势比 = 0.11，95%置信区间 = 0.02–0.69，p= 0.018） 与 AWE 的存在独立相关。随着 PHASES 评分的增加，尺寸相关参数和不规则形状的频率显着增加，并且观察到较低和振荡的壁剪切应力的血流动力学模式。同时，NAWE 动脉瘤的比例下降，而 PAWE 和 CAWE 动脉瘤的比例显着增加 (p< 0.001)。破裂风险较高的未破裂颅内动脉瘤具有明显更大的尺寸、更低的壁剪切应力和更强的AWE，这可能支持形态、血流动力学和炎症之间的相互作用及其在动脉瘤破裂预测中的潜在作用。
The purpose of this study is to investigate the relationship between morphology, hemodynamics, and aneurysm wall enhancement (AWE) on vessel wall MRI and their potential role in rupture of intracranial aneurysms. Fifty-seven patients (22 males and 35 females; mean age of 58.4) harboring 65 unruptured intracranial aneurysms were retrospectively recruited. Vessel wall MRI images were reviewed and differentiated as no (NAWE), partial (PAWE), and circumferential (CAWE) wall enhancement. Computational geometry and computational fluid dynamics were used to calculate morphological and hemodynamic parameters. The PHASES score was calculated for each case to estimate its rupture risk. Univariate and multivariate logistic regression analysis was performed to investigate the relationship between morphological-hemodynamic pattern and AWE as well as their association with rupture risk. AWE was present in 26 (40.0%) lesions, including 14 (21.5%) PAWE and 12 (18.5%) CAWE. Aneurysm size (odds ratio = 7.46, 95% confidence interval = 1.56–35.77,p= 0.012), size ratio (odds ratio = 12.90, 95% confidence interval = 2.28–72.97,p= 0.004), and normalized wall shear stress (odds ratio = 0.11, 95% confidence interval = 0.02–0.69,p= 0.018) were independently associated with the presence of AWE. With increasing PHASES score, size-related parameters and the frequency of irregular shape increased significantly, and a hemodynamic pattern of lower and oscillating wall shear stress was observed. Simultaneously, the proportion of NAWE aneurysms decreased, and PAWE and CAWE aneurysms increased significantly (p< 0.001). Unruptured intracranial aneurysms with a higher rupture risk presented with a significantly larger size, lower wall shear stress, and more intense AWE, which might support the interaction between morphology, hemodynamics, and inflammation and their potential role in aneurysm rupture prediction.