Wang Joanna Y, Smith Ryan, Ye Xiaobu, Yang Wuyang, Caplan Justin M, Radvany Martin G, Colby Geoffrey P, Coon Alexander L, Tamargo Rafael J, Huang Judy
Departments of *Neurosurgery and ‡Radiology, Division of Interventional Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Neurosurgery. 2015 Jul;77(1):32-42; discussion 42-3. doi: 10.1227/NEU.0000000000000730.
Although rare, de novo intracranial aneurysms (DNIAs) may develop in patients with a history of intracranial aneurysms (IAs).
To evaluate the benefit of routine radiographic screening for DNIAs.
Data for 2153 patients with IAs were retrospectively analyzed. A total of 185 patients underwent screening for DNIAs at frequent intervals.
Overall, DNIAs were detected in 26 patients (1.2%). Of the 185 patients with surveillance, DNIAs developed in 9 (4.9%). The risk of DNIA detection was 1.14% per person-year of follow-up (95% confidence interval: 0.6%-2.2%). Patients with imaging follow-up had a significantly higher rate of DNIA detection compared with patients without regular imaging surveillance (4.9% vs 0.86%; P < .001), but surveillance was associated with smaller lesions (with surveillance: 3.8 ± 1.8 mm, without: 7.0 ± 4.4 mm, mean ± standard deviation; P = .026). A unimodal distribution of time to detection was found in those with surveillance, with a peak between 0 and 2 years. There was a trend toward an association of cigarette smoking and DNIA detection within 10 years (P = .06); 6 of the 26 patients (23.1%) with DNIAs had a history of cigarette smoking, with all 6 patients continuing to smoke up to the detection of the DNIAs, which were detected in 2.5 ± 1.8 years.
The low 1.14% per-person year risk of DNIA detection and small DNIA size at detection cannot justify routine screening for DNIAs in all patients with a personal history of IAs. If imaging follow-up is considered for selected patients, early screening will likely yield the most benefit in patients who continue to smoke cigarettes.
尽管罕见，但颅内动脉瘤（IA）病史患者可能会发生新发颅内动脉瘤（DNIA）。
评估对DNIA进行常规影像学筛查的益处。
对2153例IA患者的数据进行回顾性分析。共有185例患者定期接受DNIA筛查。
总体而言，26例患者（1.2%）检测到DNIA。在185例接受监测的患者中，9例（4.9%）发生了DNIA。随访期间，DNIA的检出风险为每人年1.14%（95%置信区间：0.6%-2.2%）。与未进行定期影像学监测的患者相比，接受影像学随访的患者DNIA检出率显著更高（4.9%对0.86%；P <.001），但监测发现的病变较小（接受监测者：3.8±1.8mm，未接受监测者：7.0±4.4mm，均值±标准差；P = 0.026）。在接受监测的患者中，检测时间呈单峰分布，峰值出现在0至2年之间。吸烟与10年内DNIA检测之间存在关联趋势（P = 0.06）；26例DNIA患者中有6例（23.1%）有吸烟史，所有6例患者在检测到DNIA之前一直吸烟，DNIA在2.5±1.8年时被检测到。
每人年1.14%的低DNIA检出风险以及检测时DNIA的小尺寸，无法证明对所有有IA个人病史的患者进行DNIA常规筛查是合理的。如果考虑对部分患者进行影像学随访，早期筛查可能对持续吸烟的患者最有益。
