Wang Guang-Xian, Liu Lan-Lan, Yang Yan, Wen Li, Duan Chun-Mei, Yin Jin-Bo, Zhang Dong
Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Quant Imaging Med Surg. 2021 Sep;11(9):4115-4124. doi: 10.21037/qims-21-32.
The progression of an unruptured intracranial aneurysm (UIA) is associated with a higher rupture risk. The aim of this study was to identify the risk factors for the progression of UIAs among Chinese adults and compare them with the ELAPSS (Earlier subarachnoid hemorrhage, IA Location, Age, Population, IA Size and Shape) score.
Four hundred thirty-eight consecutive patients with 491 UIAs were followed and reviewed retrospectively from August 2011 to November 2019. Follow-up images of the UIAs were used to determine changes in IA size and shape. Patients and IAs were divided into non-progression and progression groups. In addition to the clinical characteristics of the patients, the features of the IAs (e.g., size and shape) were evaluated by computed tomography angiography (CTA) or magnetic resonance angiography (MRA). Independent risk factors for UIA progression were studied using multiple Cox proportional hazards regression analysis. In addition, the diagnostic value of the ELAPSS score for the prediction of UIA progression was calculated.
Seventy-two IAs in 68 patients progressed during a mean follow-up time of 24.2±19.68 months. IAs located at the bifurcation [odds ratio (OR) 2.600], with an irregular shape (OR 2.981) or having a high aspect ratio (AR, OR 2.430) were correlated with progression. Based on these three factors, the threshold value of our predictive score was 0.5, and the area under the curve (AUC), sensitivity and specificity were 0.756, 93.1% and 40.6%, respectively, while the AUC, sensitivity and specificity of the ELAPSS score were 0.711, 55.6%, and 75.2%, respectively.
IAs located at the bifurcation, with an irregular shape and with an elevated AR are risk factors for UIA progression in the Chinese population. Our predictive score is of great value in predicting the risk of UIA progression.
未破裂颅内动脉瘤（UIA）的进展与更高的破裂风险相关。本研究的目的是确定中国成年人中UIA进展的危险因素，并将其与ELAPSS（早期蛛网膜下腔出血、动脉瘤位置、年龄、人群、动脉瘤大小和形状）评分进行比较。
回顾性随访并分析了2011年8月至2019年11月期间连续收治的438例患者的491个UIA。利用UIA的随访影像来确定动脉瘤大小和形状的变化。将患者和动脉瘤分为非进展组和进展组。除患者的临床特征外，通过计算机断层血管造影（CTA）或磁共振血管造影（MRA）评估动脉瘤的特征（如大小和形状）。采用多因素Cox比例风险回归分析研究UIA进展的独立危险因素。此外，计算了ELAPSS评分对UIA进展预测的诊断价值。
在平均24.2±19.68个月的随访期内，68例患者的72个动脉瘤发生进展。位于分叉处的动脉瘤[比值比（OR）2.600]、形状不规则（OR 2.981）或高纵横比（AR，OR 2.430）与进展相关。基于这三个因素，我们预测评分的阈值为0.5，曲线下面积（AUC）、敏感性和特异性分别为0.756、93.1%和40.6%，而ELAPSS评分的AUC、敏感性和特异性分别为0.711、55.6%和75.2%。
位于分叉处、形状不规则且AR升高的动脉瘤是中国人群中UIA进展的危险因素。我们的预测评分在预测UIA进展风险方面具有重要价值。
