Morphological Variables Associated With Ruptured Middle Cerebral Artery Aneurysms
Morphological Variables Associated With Ruptured Middle Cerebral Artery Aneurysms
复制标题
与破裂的大脑中动脉动脉瘤相关的形态变量。
DOI：
10.1093/neuros/nyy213
复制
发表时间：
2019-07-01
期刊：
影响因子：
4.8
通讯作者：
Du, Rose
中科院分区：
文献类型：
--
作者：
Zhang, Jian;Can, Anil;Du, Rose
背景
颅内动脉瘤及其周围血管的几何因素可影响动脉瘤破裂的风险。然而，与颅内动脉瘤破裂相关的形态学参数的大规模评估在特定位置的方式是稀缺的。
目的
探讨大脑中动脉（MCA）动脉瘤破裂的形态学特征。
方法
本研究纳入了1990年至2016年期间诊断的561例患者（638个MCA动脉瘤），这些患者具有可用的计算机断层扫描血管造影（CTA）。使用Vitrea Advanced Visualization软件进行三维（3D）重建评价CTA。在每个模型中检查的形态学参数包括动脉瘤投影、壁不规则性、是否存在子体圆顶、是否存在发育不全或再生障碍性A1动脉和发育不全或胎儿后交通动脉（PCoA）、动脉瘤高度和宽度、瘤颈直径、瓶颈因子、纵横比和尺寸比、高度/宽度比以及周围载瘤血管和子体血管的直径和角度。进行单变量和多变量统计分析，以确定MCA动脉瘤破裂的形态学特征的相关性。Logistic回归用于建立预测MCA评分。
结果
更大的瓶颈和尺寸比，以及不规则的、多叶的、暂时突出的MCA动脉瘤与更高的破裂风险相关，而更高的M1/M2比、更大的宽度以及同侧或双侧发育不良的PCoA的存在与破裂呈负相关。MCA评分具有良好的预测能力，受试者工作曲线下面积= 0.88。
结论
在检查未破裂动脉瘤的3D重建时，这些MCA动脉瘤特有的实用形态学参数易于评估，并有助于这些患者的风险评估。
BACKGROUND
Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce.
OBJECTIVE
To investigate the morphological characteristics associated with ruptured middle cerebral artery (MCA) aneurysms.
METHODS
Five hundred sixty-one patients with 638 MCA aneurysms diagnosed between 1990 and 2016 who had available computed tomography angiography (CTA) were included in this study. CTAs were evaluated using the Vitrea Advanced Visualization software for 3-dimensional (3D) reconstruction. Morphological parameters examined in each model included aneurysm projection, wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal posterior communicating arteries (PCoA), aneurysm height and width, neck diameter, bottleneck factor, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological characteristics with rupture of MCA aneurysms. Logistic regression was used to build a predictive MCA score.
RESULTS
Greater bottleneck and size ratio, and irregular, multilobed, temporally projecting MCA aneurysms are associated with higher rupture risk, whereas higher M1/M2 ratio, larger width, and the presence of an ipsilateral or bilateral hypoplastic PCoA were inversely associated with rupture. The MCA score had good predictive capacity with area under the receiver operating curve = 0.88.
CONCLUSION
These practical morphological parameters specific to MCA aneurysms are easy to assess when examining 3D reconstructions of unruptured aneurysms and could aid in risk evaluation in these patients.