Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Eur Radiol. 2024 Nov;34(11):7517-7525. doi: 10.1007/s00330-024-10789-2. Epub 2024 May 28.
Arterial calcification is thought to protect against rupture of intracranial aneurysms, but studies in a representative population of intracranial aneurysm patients have not yet been performed. The aim was to compare the prevalence of aneurysm wall calcification and intracranial carotid artery calcification (ICAC) between patients with an unruptured intracranial aneurysm (UIA) and a ruptured intracranial aneurysm (RIA).
We matched 150 consecutive UIA patients to 150 RIA patients on age and sex. Aneurysm wall calcification and ICAC were quantified on non-contrast enhanced computed tomography images with the modified Agatston score. We compared the prevalence of aneurysm wall calcification, ICAC, and severe ICAC (defined as a modified Agatston score in the fourth quartile) between UIA and RIA patients using univariate and multivariate conditional logistic regression models adjusted for aneurysm characteristics and cardiovascular risk factors.
Aneurysm wall calcification was more prevalent in UIA compared to RIA patients (OR 5.2, 95% CI: 2.0-13.8), which persisted after adjustment (OR 5.9, 95% CI: 1.7-20.2). ICAC prevalence did not differ between the two groups (crude OR 0.9, 95% CI: 0.5-1.8). Severe ICAC was more prevalent in UIA patients (OR 2.0, 95% CI: 1.1-3.6), but not after adjustment (OR 1.0, 95% CI: 0.5-2.3).
Aneurysm wall calcification but not ICAC was more prevalent in UIAs than in RIAs, which corresponds to the hypothesis that calcification may protect against aneurysmal rupture. Aneurysm wall calcification should be further assessed as a predictor of aneurysm stability in prospective cohort studies.
Calcification of the intracranial aneurysm wall was more prevalent in unruptured than ruptured intracranial aneurysms after adjustment for cardiovascular risk factors. Calcification may therefore protect the aneurysm against rupture, and aneurysm wall calcification is a candidate predictor of aneurysm stability.
Aneurysm wall calcification was more prevalent in patients with unruptured than ruptured aneurysms, while internal carotid artery calcification was similar. Aneurysm wall calcification but not internal carotid artery calcification is a candidate predictor of aneurysm stability. Cohort studies are needed to assess the predictive value of aneurysm wall calcification for aneurysm stability.
人们认为动脉钙化可防止颅内动脉瘤破裂，但尚未在具有代表性的颅内动脉瘤患者人群中进行相关研究。本研究旨在比较未破裂颅内动脉瘤（UIA）和破裂颅内动脉瘤（RIA）患者的瘤壁钙化和颅内颈内动脉钙化（ICAC）的发生率。
我们按照年龄和性别匹配了 150 例连续的 UIA 患者和 150 例 RIA 患者。使用改良的 Agatston 评分，在非增强 CT 图像上对瘤壁钙化和 ICAC 进行定量。我们使用单变量和多变量条件逻辑回归模型，比较 UIA 和 RIA 患者的瘤壁钙化、ICAC 和严重 ICAC（定义为改良的 Agatston 评分处于第四四分位数）的发生率，并对动脉瘤特征和心血管危险因素进行了调整。
与 RIA 患者相比，UIA 患者的瘤壁钙化更为常见（OR 5.2，95%CI：2.0-13.8），调整后仍如此（OR 5.9，95%CI：1.7-20.2）。两组之间的 ICAC 发生率没有差异（粗 OR 0.9，95%CI：0.5-1.8）。UIA 患者的严重 ICAC 更为常见（OR 2.0，95%CI：1.1-3.6），但调整后并非如此（OR 1.0，95%CI：0.5-2.3）。
UIA 患者的瘤壁钙化比 RIA 患者更为常见，但 ICAC 则不然，这与钙化可能防止动脉瘤破裂的假说相符。在前瞻性队列研究中，应进一步评估瘤壁钙化作为动脉瘤稳定性的预测因子。
在调整心血管危险因素后，UIA 患者的颅内动脉瘤壁钙化比 RIA 患者更为常见。因此，钙化可能会保护动脉瘤免受破裂的影响，而动脉瘤壁钙化是动脉瘤稳定性的候选预测因子。
与破裂的颅内动脉瘤相比，未破裂的颅内动脉瘤患者的瘤壁钙化更为常见，而颈内动脉钙化则相似。瘤壁钙化而不是颈内动脉钙化是动脉瘤稳定性的候选预测因子。需要进行队列研究来评估瘤壁钙化对动脉瘤稳定性的预测价值。
