Abboud Tammam, Rustom Jihad, Bester Maxim, Czorlich Patrick, Vittorazzi Eik, Pinnschmidt Hans O, Westphal Manfred, Regelsberger Jan
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Internal Medicine, Klinikum Itzehoe, Itzehoe, Germany.
World Neurosurg. 2017 Mar;99:610-617. doi: 10.1016/j.wneu.2016.12.053. Epub 2016 Dec 23.
In addition to size and location, the morphology of intracranial aneurysms has been proposed to predict rupture. This study was undertaken to compare morphologic features between ruptured and unruptured aneurysms and identify those associated with greater risk of rupture.
Between 2010 and 2014, 301 patients with subarachnoid hemorrhage and 204 with unruptured aneurysms were admitted to our hospital. Two investigators reviewed 3-dimensional angiograms of all aneurysms. Risk factors for rupture were identified. Morphology was classified into single-sac aneurysms with smooth margin, single-sac aneurysms with irregular margin, aneurysms with a daughter sac, and multilobulated aneurysms. The value of morphology in predicting rupture was tested with the use of logistic regression.
A total of 420 aneurysms met the inclusion criteria. Multilobulated aneurysm was the most frequent finding among ruptured aneurysms, followed by single sac with irregular margin, aneurysm with daughter sac, and single sac with smooth margin (44.9%, 25.9%, 18%, and 11.2%, respectively). Among unruptured aneurysms, single sac with smooth margin was the most frequent finding, followed by single sac with irregular margin, multilobulated aneurysm, and aneurysm with daughter sac (38.1%, 29.8%, 20.9%, and 11.2%, respectively). Morphology was an independent predictor of rupture (receiver operating characteristic-area under the curve 0.693, P < 0.001). Risk of rupture increased by factor of 3 (5, 95% confidence interval [CI] 1.6-5.3) from single sac with regular margin to irregular margin, by factor of 5.5 (5, 95% CI 2.8-11.0) to daughter sac, and by factor of 7.3 (5, 95% CI 4.1-13.1) to multilobulated aneurysm.
Morphology might have an independent predictive value of aneurysm rupture. Risk of rupture might increase according to extent of morphologic change. Prospective studies will be necessary to evaluate the influence of aneurysm morphology on natural history.
除大小和位置外，颅内动脉瘤的形态也被认为可用于预测破裂。本研究旨在比较破裂和未破裂动脉瘤的形态学特征，并确定与更高破裂风险相关的特征。
2010年至2014年期间，我院收治了301例蛛网膜下腔出血患者和204例未破裂动脉瘤患者。两名研究人员对所有动脉瘤的三维血管造影进行了评估。确定了破裂的危险因素。形态学分为边缘光滑的单囊动脉瘤、边缘不规则的单囊动脉瘤、有子囊的动脉瘤和多叶状动脉瘤。使用逻辑回归检验形态学在预测破裂方面的价值。
共有420个动脉瘤符合纳入标准。多叶状动脉瘤是破裂动脉瘤中最常见的类型，其次是边缘不规则的单囊动脉瘤、有子囊的动脉瘤和边缘光滑的单囊动脉瘤（分别为44.9%、25.9%、18%和11.2%）。在未破裂动脉瘤中，边缘光滑的单囊动脉瘤最常见，其次是边缘不规则的单囊动脉瘤、多叶状动脉瘤和有子囊的动脉瘤（分别为38.1%、29.8%、20.9%和11.2%）。形态学是破裂的独立预测因素（受试者工作特征曲线下面积为0.693，P < 0.001）。从边缘规则的单囊动脉瘤到边缘不规则的单囊动脉瘤，破裂风险增加3倍（5，95%置信区间[CI] 1.6 - 5.3），到有子囊的动脉瘤增加5.5倍（5，95% CI 2.8 - 11.0），到多叶状动脉瘤增加7.3倍（5，95% CI 4.1 - 13.1）。
形态学可能对动脉瘤破裂具有独立的预测价值。破裂风险可能随形态学改变程度增加。需要进行前瞻性研究以评估动脉瘤形态学对自然病程的影响。
