Uchikawa Hiroki, Kin Taichi, Takeda Yasuhiro, Koike Tsukasa, Kiyofuji Satoshi, Koizumi Satoshi, Shiode Taketo, Suzuki Yuichi, Miyawaki Satoru, Nakatomi Hirofumi, Mukasa Akitake, Saito Nobuhito
Department of Neurosurgery, University of Tokyo, Tokyo, Japan.
Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
World Neurosurg X. 2021 Jan 13;10:100098. doi: 10.1016/j.wnsx.2021.100098. eCollection 2021 Apr.
Intraoperative rupture is the most fatal and catastrophic complication of surgery for unruptured intracranial aneurysms (UIAs); thus, it is extremely useful to predict reddish and thin-walled regions of the UIA before surgery. Although several studies have reported a relationship between the hemodynamic characteristics and intracranial aneurysm wall thickness, a consistent opinion is lacking. We aimed to investigate the relationship between objectively and quantitatively evaluated bleb wall color and hemodynamic characteristics using phase-contrast magnetic resonance angiography (PC-MRA).
Ten patients diagnosed with UIA who underwent surgical clipping and preoperative magnetic resonance imaging along with PC-MRA were included in this study. Bleb wall color was evaluated from an intraoperative video. Based on the Red (R), Green, and Blue values, bleb wall redness (modified R value; mR) was calculated and compared with the hemodynamic characteristics obtained from PC-MRA.
The wall redness distribution of 18 blebs in 11 UIAs in 10 patients was analyzed. Bleb/neck inflow velocity ratio (Vb/Va: r = 0.66, = 0.003) strongly correlated with mR, whereas bleb/neck inflow rate ratio (r = 0.58, = 0.012) correlated moderately. Multivariate regression analysis revealed that only Vb/Va ( = 0.017) significantly correlated with mR. There was no correlation between wall shear stress and mR.
The bleb redness of UIAs and Vb/Va, calculated using PC-MRA, showed a significantly greater correlation. Thus, it is possible to predict bleb thickness noninvasively before surgery. This will facilitate more detailed pre- and intraoperative strategies for clipping and coiling for safe surgery.
术中破裂是未破裂颅内动脉瘤（UIA）手术中最致命和灾难性的并发症；因此，在手术前预测UIA的微红和薄壁区域非常有用。尽管有几项研究报告了血流动力学特征与颅内动脉瘤壁厚度之间的关系，但仍缺乏一致意见。我们旨在使用相位对比磁共振血管造影（PC-MRA）研究客观定量评估的瘤壁颜色与血流动力学特征之间的关系。
本研究纳入了10例诊断为UIA并接受手术夹闭以及术前磁共振成像和PC-MRA检查的患者。从术中视频评估瘤壁颜色。基于红（R）、绿和蓝值，计算瘤壁发红程度（修正R值；mR），并与从PC-MRA获得的血流动力学特征进行比较。
分析了10例患者中11个UIA的18个瘤泡的壁发红分布情况。瘤泡/瘤颈流入速度比（Vb/Va：r = 0.66，P = 0.003）与mR密切相关，而瘤泡/瘤颈流入率比（r = 0.58，P = 0.012）中度相关。多变量回归分析显示，仅Vb/Va（P = 0.017）与mR显著相关。壁切应力与mR之间无相关性。
使用PC-MRA计算的UIA瘤泡发红程度与Vb/Va显示出显著更强的相关性。因此，术前无创预测瘤泡厚度是可能的。这将有助于制定更详细的术前和术中夹闭及栓塞策略，以实现安全手术。
