通过三维建模对破裂性和有症状的腹主动脉瘤进行形态学评估。
Morphologic evaluation of ruptured and symptomatic abdominal aortic aneurysm by three-dimensional modeling.
作者信息
Tang An, Kauffmann Claude, Tremblay-Paquet Sophie, Elkouri Stéphane, Steinmetz Oren, Morin-Roy Florence, Cloutier-Gill Laurie, Soulez Gilles
机构信息
Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.
Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada; Institute of Biomedical Engineering, Université de Montréal, Montréal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.
出版信息
J Vasc Surg. 2014 Apr;59(4):894-902.e3. doi: 10.1016/j.jvs.2013.10.097. Epub 2014 Jan 16.
OBJECTIVE
To identify geometric indices of abdominal aortic aneurysms (AAAs) on computed tomography that are associated with higher risk of rupture.
METHODS
This retrospective case-control, institutional review board-approved study involved 63 cases with ruptured or symptomatic AAA and 94 controls with asymptomatic AAA. Three-dimensional models were generated from computed tomography segmentation and used for the calculation of 27 geometric indices. On the basis of the results of univariate analysis and multivariable sequential logistic regression analyses with a forward stepwise model selection based on likelihood ratios, a traditional model based on gender and maximal diameter (Dmax) was compared with a model that also incorporated geometric indices while adjusting for gender and Dmax. Receiver operating characteristic (ROC) curves were calculated for these two models to evaluate their classification accuracy.
RESULTS
Univariate analysis revealed that gender (P = .024), Dmax (P = .001), and 14 other geometric indices were associated with AAA rupture at P < .05. In the multivariable analysis, adjusting for gender and Dmax, the AAA with a higher bulge location (P = .020) and lower mean averaged area (P = .005) were associated with AAA rupture. With these two geometric indices, the area under the ROC curve showed an improvement from 0.67 (95% confidence interval, 0.58-0.77) to 0.75 (95% confidence interval, 0.67-0.83; P < .001). Our predictive model showed comparable sensitivity (64% vs 60%) and specificity (79% vs 77%) with current treatment criteria based on gender and diameter at the point optimizing the Youden index (sensitivity + specificity - 1) on the ROC curve.
CONCLUSIONS
Two geometric indices derived from AAA three-dimensional modeling were independently associated with AAA rupture. The addition of these indices in a predictive model based on current treatment criteria modestly improved the accuracy to detect aneurysm rupture.
目的
确定计算机断层扫描上与腹主动脉瘤（AAA）破裂风险较高相关的几何指标。
方法
这项经机构审查委员会批准的回顾性病例对照研究纳入了63例破裂或有症状的AAA患者和94例无症状AAA患者作为对照。通过计算机断层扫描分割生成三维模型，并用于计算27个几何指标。基于单因素分析结果以及采用基于似然比的向前逐步模型选择的多变量序贯逻辑回归分析结果，将基于性别和最大直径（Dmax）的传统模型与在调整性别和Dmax的同时还纳入几何指标的模型进行比较。计算这两个模型的受试者操作特征（ROC）曲线以评估其分类准确性。
结果
单因素分析显示，性别（P = 0.024）、Dmax（P = 0.001）以及其他14个几何指标与AAA破裂相关，P < 0.05。在多变量分析中，在调整性别和Dmax后，凸起位置较高（P = 0.020）且平均面积较低（P = 0.005）的AAA与AAA破裂相关。有了这两个几何指标，ROC曲线下面积从0.67（95%置信区间，0.58 - 0.77）提高到了0.75（95%置信区间，0.67 - 0.83；P < 0.001）。在优化ROC曲线上的约登指数（灵敏度 + 特异性 - 1）的点上，我们的预测模型与基于性别和直径的当前治疗标准相比，显示出相当的灵敏度（64%对60%）和特异性（79%对77%）。
结论
从AAA三维建模得出的两个几何指标与AAA破裂独立相关。在基于当前治疗标准的预测模型中加入这些指标适度提高了检测动脉瘤破裂的准确性。
Zotero 插件