Department of Neurology, Asan Medical Center, Seoul, Republic of Korea.
Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Cerebrovasc Dis. 2024;53(3):327-334. doi: 10.1159/000533167. Epub 2023 Sep 11.
A proper stratification of intracranial aneurysms is critical in identifying rupture-destined aneurysms and unruptured intracranial aneurysms. We aimed to determine the utility of geometric and hemodynamic indexes in differentiating two types of aneurysms and to examine the characteristics of natural evolutionary changes of unruptured aneurysms.
Rupture-destined aneurysm refers to an aneurysm that undergoes subsequent aneurysmal subarachnoid hemorrhage (SAH). On the other hand, an unruptured intracranial aneurysm is characterized by an aneurysm that does not experience rupture during serial time-of-flight magnetic resonance angiography (TOF-MRA). In addition to geometric indexes, signal intensity gradient (SIG), an in vivo approximated wall shear stress from TOF-MRA, was measured in aneurysms. The difference between the maximum and minimum values of SIG in an aneurysm compared to parent arterial values was designated as the delta-SIG ratio.
This study analyzed 20 rupture-destined aneurysms in 20 patients and 45 unruptured intracranial aneurysms in 41 patients with follow-up TOF-MRA. While geometric indexes did not show differences between the two groups, the delta-SIG ratio was higher in the rupture-destined aneurysms (1.5 ± 0.6 vs. 1.1 ± 0.3, p = 0.032). The delta-SIG ratio showed a higher area under the receiver operating characteristic curve for SAH than the size ratio (0.72 [95% CI, 0.58-0.87] vs. 0.56 [95% CI, 0.41-0.72], p = 0.033). The longitudinal re-examination of TOF-MRA in the unruptured intracranial aneurysms revealed evidence of aneurysmal growth, while concurrently exhibiting hemodynamic stability.
The delta-SIG ratio showed higher discriminatory results between the two groups compared to geometric indexes. Aneurysmal rupture risk should be assessed by considering both geometric and hemodynamic information. This study was registered on
对颅内动脉瘤进行适当的分层对于识别破裂倾向的动脉瘤和未破裂的颅内动脉瘤至关重要。我们旨在确定几何和血流动力学指标在区分两种类型的动脉瘤中的效用，并研究未破裂动脉瘤自然演变的特征。
破裂倾向的动脉瘤是指随后发生蛛网膜下腔出血（SAH）的动脉瘤。另一方面，未破裂的颅内动脉瘤的特征是在连续的时间飞越磁共振血管造影（TOF-MRA）期间不发生破裂的动脉瘤。除了几何指标外，还测量了动脉瘤中的信号强度梯度（SIG），这是一种从 TOF-MRA 估算的活体壁切应力。与母动脉值相比，动脉瘤中 SIG 的最大值和最小值之间的差值被指定为 delta-SIG 比值。
这项研究分析了 20 名患者的 20 个破裂倾向的动脉瘤和 41 名患者的 45 个未破裂的颅内动脉瘤的后续 TOF-MRA。虽然几何指标在两组之间没有差异，但破裂倾向的动脉瘤的 delta-SIG 比值较高（1.5 ± 0.6 对 1.1 ± 0.3，p = 0.032）。delta-SIG 比值在预测 SAH 方面的受试者工作特征曲线下面积（AUC）高于大小比（0.72[95%CI，0.58-0.87]对 0.56[95%CI，0.41-0.72]，p = 0.033）。未破裂的颅内动脉瘤的 TOF-MRA 纵向复查显示了动脉瘤生长的证据，同时表现出血流动力学的稳定性。
与几何指标相比，delta-SIG 比值在两组之间显示出更高的鉴别结果。应综合考虑几何和血流动力学信息来评估动脉瘤破裂的风险。本研究在
