From the Department of Diagnostic Radiology and Nuclear Medicine (Z.-Q.H., W.-J.Y.), University of Maryland, Baltimore, Maryland.
Departments of Neurosurgery (G.X.).
AJNR Am J Neuroradiol. 2022 Aug;43(8):1131-1135. doi: 10.3174/ajnr.A7592.
Intracranial aneurysms, a rare complication of radiation therapy, have been reported mainly in case reports or case series. We performed a multicenter, retrospective cohort study to investigate the characteristics of radiation-induced intracranial aneurysms.
Data on 2641 patients with intracranial aneurysms were retrospectively collected from 3 hospitals between January 2005 and June 2014. An additional 1519 patients were recruited from a single center between July 2014 and March 2020. Aneurysms in patients with a history of radiation therapy for at least 6 months were defined as radiation-related aneurysms. Patients' demographic profiles, clinical characteristics, and aneurysm parameters detected on CTA were compared between radiation-related and control groups.
Of the 4160 patients, the average age was 57.9 (SD, 13.5) years, 2406 (57.8%) were women, 477 (11.5%) had multiple aneurysms, 3009 (72.3%) had SAH, and 34 (0.8%) had radiation-related aneurysms. The male-to-female ratio in the radiation-related group was significantly higher than that in the control group (2.4:1 versus 0.72:1, = .001). The mean age of the radiation-related group was significantly younger than in the control group (51.4 [SD, 15.0] years versus 58.2 [SD, 13.5] years, = .003). More patients in the radiation-related group presented with SAH than in the control group (without age and sex matching, 88.2% versus 72.2%, = .037; with age and sex matching, 88.2% versus 58.8%, = .006). Of the 4813 intracranial aneurysms, only 43 (0.9%) aneurysms were categorized as in the radiation-related group, whereas 4770 (99.1%) aneurysms constituted the control group. Compared with the control group, there was a significantly higher proportion of sidewall aneurysms (46.5% versus 32.3%, = .048) and a predilection for aneurysms involving the ICA and posterior circulation arteries (72.1% versus 52.2%, = .046) in the radiation-related group.
Compared with the control group, radiation-related aneurysms are more prone to occur in men and young patients, with a higher percentage of sidewall aneurysms located in the ICA and posterior circulation arteries. Furthermore, SAH is highly prevalent in patients with radiation-induced aneurysms, indicating that dedicated screening for aneurysms after radiation therapy is necessary, but further studies are needed to determine when and how to screen.
颅内动脉瘤是放疗的罕见并发症，主要见于病例报告或病例系列。我们进行了一项多中心、回顾性队列研究，以调查放疗引起的颅内动脉瘤的特征。
从 2005 年 1 月至 2014 年 6 月，我们从 3 家医院回顾性地收集了 2641 例颅内动脉瘤患者的数据。另外，我们还从一家医院招募了 2014 年 7 月至 2020 年 3 月间的 1519 例患者。将放疗后至少 6 个月发生的颅内动脉瘤定义为放疗相关动脉瘤。比较了放疗组和对照组患者的人口统计学特征、临床特征和 CTA 检测到的动脉瘤参数。
在 4160 例患者中，平均年龄为 57.9（标准差，13.5）岁，2406 例（57.8%）为女性，477 例（11.5%）有多个动脉瘤，3009 例（72.3%）有蛛网膜下腔出血，34 例（0.8%）为放疗相关动脉瘤。放疗组的男女比例明显高于对照组（2.4:1 对 0.72:1， =.001）。放疗组的平均年龄明显低于对照组（51.4[标准差，15.0]岁对 58.2[标准差，13.5]岁， =.003）。放疗组有更多的患者表现为蛛网膜下腔出血，多于对照组（无年龄和性别匹配，88.2%对 72.2%， =.037；有年龄和性别匹配，88.2%对 58.8%， =.006）。在 4813 个颅内动脉瘤中，只有 43 个（0.9%）被归类为放疗相关组，而 4770 个（99.1%）为对照组。与对照组相比，放疗组侧壁动脉瘤的比例明显更高（46.5%对 32.3%， =.048），并且更倾向于累及颈内动脉和后循环动脉的动脉瘤（72.1%对 52.2%， =.046）。
与对照组相比，放疗相关的动脉瘤更易发生在男性和年轻患者中，并且侧壁动脉瘤更多地位于颈内动脉和后循环动脉。此外，放疗后发生的颅内动脉瘤患者中蛛网膜下腔出血的发生率很高，这表明有必要对放疗后进行专门的动脉瘤筛查，但需要进一步研究以确定何时以及如何进行筛查。
