Increased Wall Enhancement Extent Representing Higher Rupture Risk of Unruptured Intracranial Aneurysms.
Increased Wall Enhancement Extent Representing Higher Rupture Risk of Unruptured Intracranial Aneurysms.
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壁强化程度增加代表未破裂颅内动脉瘤破裂风险较高
DOI：
10.3340/jkns.2020.0144
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发表时间：
2021-03
影响因子：
1.6
通讯作者：
Zhang X
中科院分区：
文献类型：
--
作者：
Jiang Y;Xu F;Huang L;Lu G;Ge L;Wan H;Geng D;Zhang X
本研究旨在基于磁共振血管壁成像（MR - VWI）定量方法探讨动脉瘤壁强化与临床破裂风险之间的关系。
2016年2月至2017年10月前瞻性纳入108例患者的127个未破裂动脉瘤。根据PHASES（人群、高血压、年龄、动脉瘤大小、其他动脉瘤既往蛛网膜下腔出血史、动脉瘤部位）评分将动脉瘤分为高风险（≥10分）和中低风险组（<10分）。分析并比较临床危险因素、动脉瘤形态以及使用3D MR - VWI计算的壁强化指数（WEI）。
在高风险组和中低风险组的比较中，单因素分析显示，瘤颈宽度（4.5±3.3毫米对3.4±1.7毫米，p = 0.002）、存在壁强化（100.0%对62.9%，p < 0.001）以及WEI（1.6±0.6对0.8±0.8，p < 0.001）与高破裂风险显著相关。多因素回归分析显示，WEI是预测高破裂风险的最重要因素（比值比为2.6；95%置信区间为1.4 - 4.9；p = 0.002）。受试者工作特征（ROC）曲线分析能够有效区分高风险动脉瘤（曲线下面积为0.780；p < 0.001），其具有可靠的WEI临界值（1.04；敏感度为0.833；特异度为0.67）可预测高破裂风险。
基于PHASES评分具有较高破裂风险的动脉瘤表现出瘤颈增宽、壁强化以及强化程度增加。未破裂动脉瘤中较高的WEI对破裂风险增加具有预测价值。
Objective This study aims to investigate the relationship between aneurysm wall enhancement and clinical rupture risks based on the magnetic resonance vessel wall imaging (MR-VWI) quantitative methods. Methods One hundred and eight patients with 127 unruptured aneurysms were prospectively enrolled from Feburary 2016 to October 2017. Aneurysms were divided into high risk (≥10) and intermediate-low risk group (<10) according to the PHASES (Population, Hypertension, Age, Size of aneurysm, Earlier SAH history from another aneurysm, Site of aneurysm) scores. Clinical risk factors, aneurysm morphology, and wall enhancement index (WEI) calculated using 3D MR-VWI were analyzed and compared. Results In comparison of high-risk and intermediated-low risk groups, univariate analysis showed that neck width (4.5±3.3 mm vs. 3.4±1.7 mm, p=0.002), the presence of wall enhancement (100.0% vs. 62.9%, p<0.001), and WEI (1.6±0.6 vs. 0.8±0.8, p<0.001) were significantly associated with high rupture risk. Multivariate regression analysis revealed that WEI was the most important factor in predicting high rupture risk (odds ratio, 2.6; 95% confidence interval, 1.4–4.9; p=0.002). The receiver operating characteristic (ROC) curve analysis can efficiently differentiate higher risk aneurysms (area under the curve, 0.780; p<0.001) which have a reliable WEI cutoff value (1.04; sensitivity, 0.833; specificity, 0.67) predictive of high rupture risk. Conclusion Aneurysms with higher rupture risk based on PHASES score demonstrate increased neck width, wall enhancement, and the enhancement intensity. Higher WEI in unruptured aneurysms has a predictive value for increased rupture risk.
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影响因子：
4.8
作者：
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通讯作者：
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