前循环动脉瘤患者的瘤壁强化相关临床及形态学特征和强化模式。
The Clinical and Morphologic Features Related to Aneurysm Wall Enhancement and Enhancement Pattern in Patients with Anterior Circulation Aneurysms.
机构信息
Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China; Shandong Key Laboratory of Brain Function Remodeling, Jinan, China.
Department of Pharmacy, Yinan County People's Hospital, Linyi, China.
出版信息
World Neurosurg. 2020 Feb;134:e649-e656. doi: 10.1016/j.wneu.2019.10.156. Epub 2019 Nov 2.
BACKGROUND
Aneurysm wall enhancement (AWE) may predict rupture-prone intracranial aneurysms (IAs). However, the clinical and morphologic risk factors related to AWE have not been well described. Furthermore, the risk factors related to enhancement patterns have never been studied, especially in patients with anterior circulation aneurysms. Therefore, we aimed to investigate the risk factors related to wall enhancement and the enhancement patterns in anterior circulation unruptured aneurysms.
METHODS
One hundred patients (median age, 59 years; 68% female) with 113 anterior circulation unruptured aneurysms were included in this prospective study. Clinical and morphologic risk factors related to wall enhancement and circumferential enhancement were analyzed using univariate and multivariate analyses.
RESULTS
There were 33 symptomatic unruptured IAs (29.2%) and 50 IAs with AWE (44.2%) (partial [n = 16] and circumferential [n = 34]). Univariate analysis showed that symptomatic IAs and morphologic factors (irregular shape, size, width, dome depth, size ratio, aspect ratio, and bottleneck) correlated with wall enhancement. Furthermore, female sex, blood parameters (cholesterol and low-density lipoprotein), and morphologic factors (size and dome depth) correlated with wall enhancement patterns (P <0.05). Multivariate analysis showed that size was the most important factor in wall enhancement (P = 0.06; odds ratio, 3.758) and a trend for symptomatic IAs (P = 0.033; odds ratio, 2.426). Female sex was the most important factor in circumferential enhancement (P = 0.017; odds ratio, 7.276).
CONCLUSIONS
AWE was strongly associated with aneurysm size and was observed more frequently in symptomatic unruptured IAs. Sex hormones and atherosclerotic factors may be involved in circumferential enhancement. However, further studies should be performed to investigate the pathologic mechanisms for pattern of enhancement.
背景
动脉瘤壁增强（AWE）可能预测易破裂的颅内动脉瘤（IAs）。然而，与 AWE 相关的临床和形态学危险因素尚未得到很好的描述。此外，从未研究过与增强模式相关的危险因素，特别是在前循环动脉瘤患者中。因此，我们旨在研究与前循环未破裂动脉瘤壁增强和增强模式相关的危险因素。
方法
本前瞻性研究纳入了 100 例（中位年龄 59 岁，68%为女性）患有 113 个前循环未破裂动脉瘤的患者。使用单变量和多变量分析分析了与壁增强和环形增强相关的临床和形态学危险因素。
结果
有 33 个症状性未破裂的 IAs（29.2%）和 50 个有 AWE 的 IAs（44.2%）（部分[ n=16]和环形[ n=34]）。单变量分析表明，症状性 IAs 和形态学因素（不规则形状、大小、宽度、瘤顶深度、大小比、长宽比和瓶颈）与壁增强相关。此外，女性、血液参数（胆固醇和低密度脂蛋白）和形态学因素（大小和瘤顶深度）与壁增强模式相关（P<0.05）。多变量分析表明，大小是壁增强的最重要因素（P=0.06；优势比，3.758），并且与症状性 IAs 呈趋势相关（P=0.033；优势比，2.426）。女性是环形增强的最重要因素（P=0.017；优势比，7.276）。
结论
AWE 与动脉瘤大小密切相关，在前循环未破裂的症状性 IAs 中更为常见。性激素和动脉粥样硬化因素可能参与环形增强。然而，应进一步开展研究以探讨增强模式的病理机制。
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