Utility of skull X-rays in identifying recurrence of coiled cerebral aneurysms.
Utility of skull X-rays in identifying recurrence of coiled cerebral aneurysms.
复制标题
颅骨 X 射线在识别盘绕脑动脉瘤复发中的效用。
DOI：
10.7461/jcen.2021.e2020.10.002
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Day AL
中科院分区：
文献类型：
--
作者：
Chen PR;Lopez-Rivera V;Conner CR;Sanzgiri A;Sheth SA;Erkmen K;Kim DH;Day AL
血管内弹簧圈栓塞术后脑动脉瘤复发率高，促使使用数字减影血管造影术（DSA）进行间隔随访。然而，颅骨X射线作为动脉瘤复发的替代筛查方法的实用性是不恰当的。破裂和未破裂脑动脉瘤前瞻性登记研究的回顾性审查。在手术结束时和6个月随访时立即获得前后位和侧颅X线片。通过比较术后和6个月DSA成像确定动脉瘤复发。真阳性定义为DSA上至少一个投影上的弹簧圈肿块形态变化伴动脉瘤复发，真阴性定义为两个投影上的弹簧圈肿块稳定且DSA上无复发。使用受试者工作特征曲线下面积（AUC）统计量评估颅骨X线在识别动脉瘤复发方面的性能。对118例脑动脉瘤进行了DSA成像和头颅X线检查。在颅骨X线片的一个投影上，线圈质量形态的变化正确地检测到所有真正的复发，灵敏度为100%（95%置信区间[CI]，91-100%）。颅骨X线片未能识别15例稳定的动脉瘤弹簧圈质量，特异性为79%（68-88%）。在确定动脉瘤复发时，使用AUC 0.8958（95% CI，0.8490-0.9431）进行颅骨X线检查。我们的研究结果表明，颅骨X线检查可能是一种低成本、无创的筛查工具，可排除动脉瘤复发，这可能有助于减少DSA在弹簧圈栓塞脑动脉瘤患者随访中的使用。
A high rate of cerebral aneurysm recurrence following endovascular coiling has prompted the use of digital subtraction angiography (DSA) for interval follow-up. However, the utility of skull x-rays as an alternative screening method for aneurysm recurrence is unproperly characterized. Retrospective review of a prospective registry of ruptured and unruptured cerebral aneurysms. Anteroposterior and lateral skull x-rays were obtained immediately at the end of the procedure and at 6-month follow-up. Aneurysm recurrence was defined by comparing post-procedure and 6-month DSA imaging. A true positive was defined as a change in coil mass morphology on at least one projection with aneurysm recurrence on DSA, and a true negative defined as a stable coil mass on both projections and no recurrence on DSA. Receiver operating characteristic area under the curve (AUC) statistics was used to assess the performance of skull x-rays in identifying aneurysm recurrence. A total of 118 cerebral aneurysms were evaluated with DSA imaging and skull x-rays. A change in coil mass morphology on one projection of skull x-rays correctly detected all true recurrences with a sensitivity of 100% (95% confidence interval [CI], 91-100%). Skull x-rays failed to identify a stable aneurysm coil mass in 15 cases, with a specificity of 79% (68-88%). Skull x-rays performed with AUC 0.8958 (95% CI, 0.8490-0.9431) in identifying aneurysm recurrence. The findings of our study suggest that skull x-rays may represent a low-cost, non-invasive screening tool to rule out aneurysm recurrence, which can potentially aid in decreasing the utilization of DSA in the follow-up of patients with coiled cerebral aneurysms.