Chen Shiyao, Lv Nan, Qian Yu, Zhang Mingwei, Zhang Tianyi, Cheng Yunzhang
School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China.
Cerebrovascular Disease Center, First Affiliated Hospital of Naval Military Medical University, Changhai Hospital of Shanghai, Shanghai, China.
Front Neurol. 2024 Mar 28;15:1302874. doi: 10.3389/fneur.2024.1302874. eCollection 2024.
Irregular pulsation of the aneurysmal wall has been suggested as a novel predictor for aneurysm rupture. Aneurysm volume variations during the cardiac cycle and the association between irregular pulsation and morphological features have been discussed, but the clinical significance remains unclear. The purpose of this study was to quantify changes in morphological characteristics over the cardiac cycle and examine their correlation with irregular pulsation to facilitate comprehension of aneurysm dynamics.
Fourteen unruptured intracranial aneurysms (UIAs) from 11 patients were included in this study, and each of them underwent 4D-CTA after diagnosis by DSA. The R-R intervals were divided into 20-time phases at 5% intervals to determine whether an aneurysm had irregular pulsation throughout the cardiac cycle. CT images from the 20-time phases were used to reconstruct 3D aneurysm models, measure 14 morphological parameters, and quantify each parameter's absolute change and relative rates of change during the cardiac cycle.
Seven of 14 UIAs exhibited irregular pulsation over the cardiac cycle by 4D-CTA, 5 of which were small aneurysms ( 7 mm). The UIAs with irregular pulsation exhibited greater changes in morphological characteristics. As aneurysm size increased, the absolute change in aneurysm volume increased ( = 0.035), but the relative rates of change in aneurysm size ( = 0.013), height ( = 0.014), width ( = 0.008), height-to-width ratio ( = 0.009), dome-to-neck ratio ( = 0.019) and bottleneck factor ( = 0.012) decreased.
Although the larger the aneurysm, the greater the amplitude of its volumetric variation, small aneurysms are prone to irregular pulsation during the cardiac cycle and have more pronounced and dramatic morphological changes during the cardiac cycle that may increase the risk of rupture. This proof-of-concept study could help to explain the importance of dynamic changes using 4D-CTA in assessing the rupture risk of UIAs.
动脉瘤壁的不规则搏动已被认为是动脉瘤破裂的一种新的预测指标。已经讨论了心动周期中动脉瘤体积的变化以及不规则搏动与形态学特征之间的关联，但临床意义仍不明确。本研究的目的是量化心动周期中形态学特征的变化，并检查它们与不规则搏动的相关性，以便更好地理解动脉瘤的动态变化。
本研究纳入了11例患者的14个未破裂颅内动脉瘤（UIA），每个动脉瘤在经数字减影血管造影（DSA）诊断后均接受了四维CT血管造影（4D-CTA）检查。将R-R间期以5%的间隔分为20个时间阶段，以确定动脉瘤在整个心动周期中是否存在不规则搏动。利用这20个时间阶段的CT图像重建三维动脉瘤模型，测量14个形态学参数，并量化每个参数在心动周期中的绝对变化和相对变化率。
通过4D-CTA检查，14个UIA中有7个在心动周期中表现出不规则搏动，其中5个为小动脉瘤（直径≤7mm）。有不规则搏动的UIA在形态学特征上表现出更大的变化。随着动脉瘤大小的增加，动脉瘤体积的绝对变化增加（r=0.035），但动脉瘤大小（r=0.013）、高度（r=0.014）、宽度（r=0.008）、高宽比（r=0.009）、瘤顶颈比（r=0.019）和瓶颈因子（r=0.012）的相对变化率降低。
尽管动脉瘤越大，其体积变化的幅度越大，但小动脉瘤在心动周期中更容易出现不规则搏动，并且在心动周期中具有更明显和剧烈的形态学变化，这可能会增加破裂风险。这项概念验证研究有助于解释使用4D-CTA评估UIA破裂风险时动态变化的重要性。
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