Hoffman Haydn, Toshkezi Gentian, Swarnkar Amar, Gould Grahame, Chin Lawrence S, Krishnamurthy Satish
Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA.
Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA.
J Clin Neurosci. 2019 Feb;60:88-92. doi: 10.1016/j.jocn.2018.09.025. Epub 2018 Oct 9.
There are few reliable morphologic indices to aid in the determination of an intracranial aneurysm's rupture risk. We sought to characterize morphological characteristics of aneurysm sacs and their lobes that are associated with ruptured status at time of initial evaluation with diagnostic angiography. These factors could be associated with an aneurysm's risk of rupturing. We retrospectively reviewed all aneurysms imaged with digital subtraction angiography (DSA) at a single institution over five years. Patients presenting with aneurysmal subarachnoid hemorrhage (aSAH) were assigned to the ruptured group, and those presenting without aSAH were assigned to the unruptured group. Angiograms were evaluated for the presence of various morphological parameters. Binary logistic regression was used to assess their associations between groups. A total of 331 aneurysms among 241 patients were included in the analysis. Posterior circulation, larger size ratio, and the presence of two or more lobes were associated with aneurysm rupture (p < 0.001 for each). Aneurysms containing a lobe with a greater height than width were observed more frequently in the ruptured group (OR 5.26, 95% CI 2.66-10.41). In the receiver operating characteristic (ROC) curves, mean diameter had an AUC of 0.72 and an optimum threshold of 2.85 mm. For size ratio, the AUC was 0.70 and the optimum threshold was 2.02. A larger SR was observed in ruptured aneurysms. The presence of multiple lobes and greater lobe height than width were associated with rupture status as well. These factors merit investigation in a prospective study.
几乎没有可靠的形态学指标可用于辅助确定颅内动脉瘤的破裂风险。我们试图描述动脉瘤囊及其叶的形态学特征，这些特征与诊断性血管造影初始评估时的破裂状态相关。这些因素可能与动脉瘤的破裂风险相关。我们回顾性分析了一家机构在五年内通过数字减影血管造影（DSA）成像的所有动脉瘤。出现动脉瘤性蛛网膜下腔出血（aSAH）的患者被归入破裂组，未出现aSAH的患者被归入未破裂组。评估血管造影中各种形态学参数的存在情况。采用二元逻辑回归评估两组之间的关联。分析纳入了241例患者中的331个动脉瘤。后循环、较大的大小比以及两个或更多叶的存在与动脉瘤破裂相关（每项p<0.001）。在破裂组中，观察到高度大于宽度的叶的动脉瘤更为常见（比值比5.26，95%置信区间2.66 - 10.41）。在受试者工作特征（ROC）曲线中，平均直径的曲线下面积（AUC）为0.72，最佳阈值为2.85毫米。对于大小比，AUC为0.70，最佳阈值为2.02。破裂动脉瘤的大小比更大。多个叶的存在以及叶高度大于宽度也与破裂状态相关。这些因素值得在前瞻性研究中进行调查。
