Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China.
Hebei Medical University, China.
J Neuroradiol. 2022 Sep;49(5):392-397. doi: 10.1016/j.neurad.2021.12.001. Epub 2021 Dec 8.
To investigate the association of middle cerebral artery (MCA) bifurcation aneurysms with bifurcation morphology.
205 patients were enrolled, including 61 patients with MCA bifurcation aneurysms and 144 non-aneurysmal subjects. Aneurysmal cases were divided into types C (aneurysm neck on extension of the parent artery centerline) and D (deviating neck). The radius of the parent artery M1 (R) and bilateral branches (R and R, respectively), smaller (φ) and larger (φ) lateral angles, bifurcation angle, and arterial tortuosity from parent vessel to bilateral branches (T and T, respectively) were analyzed. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to identify risk factors and predictive values for MCA aneurysm presence and types.
In aneurysmal MCA bifurcations, bifurcating angle, T, T and R were significantly larger (P<0.01), while φ was significantly smaller (P<0.001) than those in controls. The bifurcation angle, T and LogitP were better morphological parameters for predicting MCA aneurysm presence with the AUC of 0.795, 0.932 and 0.951, respectively. Significant (P<0.05) differences were observed in the bifurcation angle, φ, R, R and T between types C and D aneurysmal bifurcations. T was an independent factor in discriminating types C from D aneurysms with an AUC of 0.802.
Bifurcation angle and arterial tortuosity from the parent artery to the branch forming a smaller angle with the parent artery have a higher value in distinguishing MCA aneurysmal from non-aneurysmal ones, and the tortuosity from the parent artery to the contralateral branch is the best indicator for distinguishing types C from D aneurysmal bifurcations.
探讨大脑中动脉（MCA）分叉部动脉瘤与分叉形态的关系。
共纳入 205 例患者，其中 61 例为 MCA 分叉部动脉瘤患者，144 例为非动脉瘤患者。将动脉瘤病例分为 C 型（瘤颈位于母动脉中心线的延长线上）和 D 型（偏离的瘤颈）。分析母动脉 M1（R）和双侧分支（R 和 R）的半径、较小（φ）和较大（φ）的侧角、分叉角以及从母血管到双侧分支的动脉迂曲度（T 和 T）。采用 Logistic 回归和受试者工作特征（ROC）曲线分析，确定 MCA 动脉瘤存在和类型的危险因素和预测值。
在动脉瘤性 MCA 分叉中，分叉角、T、T 和 R 明显增大（P<0.01），而φ明显减小（P<0.001）。分叉角、T 和 LogitP 是预测 MCA 动脉瘤存在的较好形态学参数，其 AUC 分别为 0.795、0.932 和 0.951。C 型和 D 型动脉瘤分叉中分叉角、φ、R、R 和 T 差异有统计学意义（P<0.05）。T 是区分 C 型和 D 型动脉瘤的独立因素，其 AUC 为 0.802。
从母动脉到分支的分叉角度和动脉迂曲度与母动脉形成较小的角度对区分 MCA 动脉瘤与非动脉瘤有较高的价值，从母动脉到对侧分支的迂曲度是区分 C 型和 D 型动脉瘤分叉的最佳指标。
