Early diffusion-weighted MRI lesions after treatment of unruptured intracranial aneurysms: a prospective study.
Early diffusion-weighted MRI lesions after treatment of unruptured intracranial aneurysms: a prospective study.
复制标题
未破裂颅内动脉瘤治疗后的早期弥散加权 MRI 病变：一项前瞻性研究。
DOI：
10.3171/2016.2.jns152456
复制
发表时间：
2017
影响因子：
4.1
通讯作者：
V. Seifert
中科院分区：
文献类型：
--
作者：
J. Platz;M. Wagner;E. Güresir;Se;J. Konczalla;R. D. D. de Rochemont;J. Berkefeld;V. Seifert
目的应用弥散加权MRI评估显微手术夹持（MC）和血管内线圈（EC）修复未破裂颅内动脉瘤（UIA）后术中病变负荷。方法UIA患者根据跨学科共识进行MC或EC治疗，并在动脉瘤治疗前1天和治疗后1天进行弥散加权成像（DWI）检查。治疗后DWI新发现的病变是本前瞻性研究的主要终点。DWI检测到的病变分为：A) 1-3个DWI斑点< 10 mm， B) >0个DWI斑点< 10 mm， C)单个DWI斑点> 10 mm， D)与手术通路相关的DWI病变。结果2010 - 2014年共纳入99例。MC组62例，EC组37例。两组患者在年龄、性别、动脉瘤大小、1例患者是否出现多发动脉瘤、治疗前DWI检查是否存在病变等方面均无显著差异。经EC治疗的动脉瘤位于后循环的发生率明显更高（p < 0.001）。弥散加权MRI在MC和EC后分别检测到27例（43.5%）和20例（54.1%）的新病变（无统计学意义）。DWI检测的病变形态在两组间差异有统计学意义（p < 0.001）。DWI微栓子病变（A， 14例；B， 5例）在EC后较MC后多见（A， 5例），而C、D在EC后少见（C， 1例），MC后多见（C， 12例，D， 10例）。未发现与手术相关的不良结果。结论根据具体的技术，MC和EC的病变模式不同，而UIA闭塞后DWI上发现新病变的频率相似。总的来说，两组的病变负荷都很低，而且病变在临床上没有症状。临床试验注册号：： NCT01490463 （clinicaltrials.gov）。
OBJECTIVE Diffusion-weighted MRI was used to assess periprocedural lesion load after repair of unruptured intracranial aneurysms (UIA) by microsurgical clipping (MC) and endovascular coiling (EC). METHODS Patients with UIA were assigned to undergo MC or EC according to interdisciplinary consensus and underwent diffusion-weighted imaging (DWI) 1 day before and 1 day after aneurysm treatment. Newly detected lesions by DWI after treatment were the primary end point of this prospective study. Lesions detected by DWI were categorized as follows: A) 1-3 DWI spots < 10 mm, B) > 3 DWI spots < 10 mm, C) single DWI lesion > 10 mm, or D) DWI lesion related to surgical access. RESULTS Between 2010 and 2014, 99 cases were included. Sixty-two UIA were treated by MC and 37 by EC. There were no significant differences between groups in age, sex, aneurysm size, occurrence of multiple aneurysms in 1 patient, or presence of lesions detected by DWI before treatment. Aneurysms treated by EC were significantly more often located in the posterior circulation (p < 0.001). Diffusion-weighted MRI detected new lesions in 27 (43.5%) and 20 (54.1%) patients after MC and EC, respectively (not significant). The pattern of lesions detected by DWI varied significantly between groups (p < 0.001). Microembolic lesions (A and B) found on DWI were detected more frequently after EC (A, 14 cases; B, 5 cases) than after MC (A, 5 cases), whereas C and D were rare after EC (C, 1 case) and occurred more often after MC (C, 12 cases and D, 10 cases). No procedure-related unfavorable outcomes were detected. CONCLUSIONS According to the specific techniques, lesion patterns differ between MC and EC, whereas the frequency of new lesions found on DWI is similar after occlusion of UIA. In general, the lesion load was low in both groups, and lesions were clinically silent. Clinical trial registration no.: NCT01490463 ( clinicaltrials.gov ).