Skodvin Torbjørn Øygard, Johnsen Liv-Hege, Gjertsen Øivind, Isaksen Jørgen Gjernes, Sorteberg Angelika
From the UiT The Arctic University of Norway, Tromsø (T.Ø.S., J.G.I.); University Hospital of Northern Norway, Tromsø (L.-H.J., J.G.I.); Oslo University Hospital Rikshospitalet, Norway (Ø.G., A.S.); and Institute of Clinical Medicine, University of Oslo, Norway (A.S.).
Stroke. 2017 Apr;48(4):880-886. doi: 10.1161/STROKEAHA.116.015288. Epub 2017 Mar 6.
Using postrupture morphology to predict rupture risk of an intracranial aneurysm may be inaccurate because of possible morphological changes at or around the time of rupture. The present study aims at comparing morphology from angiograms obtained prior to and just after rupture and to evaluate whether postrupture morphology is an adequate surrogate for rupture risk.
Case series of 29 aneurysms from a nationwide retrospective data collection. Two neuroradiologists who were blinded to pre- versus postrupture images assessed predefined morphological parameters independently and reached consensus regarding all measurements. Prerupture morphology and respective changes after rupture were quantified and linked to risk factors and to the risk of rupture according to the PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, site of aneurysm) and unruptured intracranial aneurysm treatment (UIAT) scores.
All 1-dimensional parameter medians were significantly larger after rupture, except neck diameter. Number of aneurysms with daughter sacs was 9 (31%) before and 17 (59%) after rupture (=0.005). Aneurysm growth from the images prior to and just after rupture increased with the time elapsed between images. Aneurysms in patients with hypertension were significantly larger at diagnosis. Prerupture morphology did not differ in relation to smoke status. Clinical risk factors were not significantly associated with morphological change.
The changes in aneurysm morphology observed after rupture reflect the compound effect of time with successive growth and formation of irregularities and the impact of rupture per se. Postrupture morphology should not be considered an adequate surrogate for the prerupture morphology in the evaluation of rupture risk.
由于颅内动脉瘤破裂时或破裂前后可能发生形态学改变，利用破裂后的形态学来预测颅内动脉瘤的破裂风险可能不准确。本研究旨在比较破裂前和破裂后即刻血管造影的形态学，并评估破裂后的形态学是否足以替代破裂风险。
从全国性回顾性数据收集中选取29个动脉瘤的病例系列。两名对破裂前和破裂后图像不知情的神经放射科医生独立评估预先定义的形态学参数，并就所有测量结果达成共识。根据PHASES（人群、高血压、年龄、动脉瘤大小、另一个动脉瘤先前的蛛网膜下腔出血、动脉瘤部位）和未破裂颅内动脉瘤治疗（UIAT）评分，对破裂前形态学及破裂后的相应变化进行量化，并将其与风险因素及破裂风险相关联。
除颈部直径外，所有一维参数中位数在破裂后均显著增大。有子囊的动脉瘤数量在破裂前为9个（31%），破裂后为17个（59%）（P=0.005）。从破裂前和破裂后即刻图像来看，动脉瘤的生长随图像间时间间隔的增加而增大。高血压患者的动脉瘤在诊断时显著更大。破裂前形态学与吸烟状况无关。临床风险因素与形态学变化无显著关联。
破裂后观察到的动脉瘤形态学变化反映了时间与连续生长、不规则形成的复合效应以及破裂本身的影响。在评估破裂风险时，不应将破裂后的形态学视为破裂前形态学的充分替代指标。
