Chen Peng Roc, Lopez-Rivera Victor, Conner Christopher R, Sanzgiri Aditya, Sheth Sunil A, Erkmen Kadir, Kim Dong H, Day Arthur L
Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA.
Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA.
J Cerebrovasc Endovasc Neurosurg. 2021 Jun;23(2):108-116. doi: 10.7461/jcen.2021.E2020.10.002. Epub 2021 Apr 28.
A high rate of cerebral aneurysm recurrence following endovascular coiling has prompted the use of digital subtraction angiography (DSA) for interval follow-up. However, the utility of skull x-rays as an alternative screening method for aneurysm recurrence is unproperly characterized.
Retrospective review of a prospective registry of ruptured and unruptured cerebral aneurysms. Anteroposterior and lateral skull x-rays were obtained immediately at the end of the procedure and at 6-month follow-up. Aneurysm recurrence was defined by comparing post-procedure and 6-month DSA imaging. A true positive was defined as a change in coil mass morphology on at least one projection with aneurysm recurrence on DSA, and a true negative defined as a stable coil mass on both projections and no recurrence on DSA. Receiver operating characteristic area under the curve (AUC) statistics was used to assess the performance of skull x-rays in identifying aneurysm recurrence.
A total of 118 cerebral aneurysms were evaluated with DSA imaging and skull x-rays. A change in coil mass morphology on one projection of skull x-rays correctly detected all true recurrences with a sensitivity of 100% (95% confidence interval [CI], 91-100%). Skull x-rays failed to identify a stable aneurysm coil mass in 15 cases, with a specificity of 79% (68-88%). Skull x-rays performed with AUC 0.8958 (95% CI, 0.8490-0.9431) in identifying aneurysm recurrence.
The findings of our study suggest that skull x-rays may represent a lowcost, non-invasive screening tool to rule out aneurysm recurrence, which can potentially aid in decreasing the utilization of DSA in the follow-up of patients with coiled cerebral aneurysms.
血管内栓塞治疗后脑动脉瘤的高复发率促使采用数字减影血管造影（DSA）进行定期随访。然而，颅骨X线作为动脉瘤复发的替代筛查方法的效用尚未得到充分描述。
对破裂和未破裂脑动脉瘤的前瞻性登记进行回顾性研究。在手术结束时和6个月随访时立即拍摄颅骨正侧位X线片。通过比较术后和6个月时的DSA成像来定义动脉瘤复发。真阳性定义为至少一个投照上的弹簧圈团块形态改变且DSA显示动脉瘤复发，真阴性定义为两个投照上的弹簧圈团块稳定且DSA无复发。采用曲线下面积（AUC）统计的受试者操作特征曲线来评估颅骨X线在识别动脉瘤复发方面的性能。
共对118个脑动脉瘤进行了DSA成像和颅骨X线评估。颅骨X线片一个投照上的弹簧圈团块形态改变能正确检测出所有真复发，灵敏度为100%（95%置信区间[CI]，91-100%）。颅骨X线未能在15例中识别出稳定的动脉瘤弹簧圈团块，特异度为79%（68-88%）。颅骨X线在识别动脉瘤复发方面的AUC为0.8958（95%CI，0.8490-0.9431）。
我们的研究结果表明，颅骨X线可能是一种低成本、非侵入性的筛查工具，可用于排除动脉瘤复发，这可能有助于减少DSA在脑动脉瘤栓塞患者随访中的使用。
