中国汉族人群有或无小泡的中小型颅内动脉瘤的患病率、形态及血流动力学

Prevalence, Geometry, and Hemodynamics of Small and Medium-Sized Intracranial Aneurysms With and Without Blebs in the Chinese Han Population.

作者信息

Cui Xiaopeng, Zhao Yan, Wang Liang, Jin Yujing, Yang Zhenglong, Li Yaohua, Zhao Zilin, Zhang Hengrui, Wei Kai, Sun Zhennan, Huai Peng, Chen Lei, Yang Xinyu

机构信息

Department of Neurosurgery, Tianjin Fifth Central Hospital, Tianjin, China.

Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.

出版信息

J Cent Nerv Syst Dis. 2025 Aug 6;17:11795735251364919. doi: 10.1177/11795735251364919. eCollection 2025.

DOI:10.1177/11795735251364919

PMID:40777514

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12329196/

Abstract

BACKGROUND

Blebs are small bulges on the surface of intracranial aneurysms (IAs) that increase rupture risk. Among Chinese individuals, the prevalence, distribution, and clinical, geometric, and local hemodynamic characteristics of small- and medium-sized (<15 mm) blebbed IAs remain unclear.

OBJECTIVES

To investigate the prevalence, distribution, and associated clinical, geometric, and hemodynamic features of blebs in small- and medium-sized IAs among Chinese patients, and to identify predictors of aneurysm rupture and bleb formation.

DESIGN

A retrospective observational study.

METHODS

CTA or DSA data from 214 patients with ruptured (RIAs) and unruptured IAs (UIAs) (<15 mm), with or without blebs, were analyzed. Three-dimensional reconstruction, geometric measurement, and computational fluid dynamics (CFD) analysis were conducted using Mimics and ANSYS Fluent. Hemodynamic parameters were assessed across the neck, body, and dome, and logistic regression was used to identify predictors of rupture and bleb formation.

RESULTS

Aneurysms from 214 patients (93 men, 121 women; mean age 59.90 ± 11.76 years) were analyzed. Blebs were found in 107 aneurysms (56.7% of RIAs, 39.1% of UIAs). They were more frequent in ACoA, PCoA, and bifurcation aneurysms (all < 0.05) and were associated with rupture. RIAs had larger blebs than UIAs (2.73 ± 1.28 mm vs 2.06 ± 1.07 mm, = 0.009). Blebbed IAs exhibited larger size, more irregular shape, higher AR, SR, BN, HWR, and lower NWSS, TAWSS, OSI (all < 0.05). SR was the strongest rupture predictor (AUC = 0.718, SR > 1.3144). Aneurysms at ACoA (OR = 8.812,CI:2.455-31.634), PCoA (OR = 6.376,CI:2.094-19.414), and high SR (OR = 2.738,CI:0.98-7.651) were significant rupture risk factors. PCoA (OR = 2.261,CI:0.759-6.739) and SR (OR = 4.683,CI:1.937-11.324) independently predicted bleb formation.

CONCLUSION

Blebs are common in small- and medium-sized IAs, especially at the ACoA, PCoA, and bifurcations, and are associated with an increased risk of rupture. Larger blebs are more often seen in ruptured IAs. A high SR is a key predictor of both rupture and bleb formation. Further studies on bleb-related hemodynamics in the neck, body, and dome are warranted.

摘要

背景

脑膨出是颅内动脉瘤（IA）表面的小凸起，会增加破裂风险。在中国人群中，中小型（<15mm）有脑膨出的IA的患病率、分布以及临床、几何和局部血流动力学特征仍不清楚。

目的

研究中国患者中小型IA中脑膨出的患病率、分布以及相关的临床、几何和血流动力学特征，并确定动脉瘤破裂和脑膨出形成的预测因素。

设计

一项回顾性观察研究。

方法

分析214例有或无脑膨出的破裂IA（RIA）和未破裂IA（UIA）（<15mm）患者的CTA或DSA数据。使用Mimics和ANSYS Fluent进行三维重建、几何测量和计算流体动力学（CFD）分析。评估瘤颈、瘤体和瘤顶的血流动力学参数，并使用逻辑回归确定破裂和脑膨出形成的预测因素。

结果

分析了214例患者（93例男性，121例女性；平均年龄59.90±11.76岁）的动脉瘤。在107个动脉瘤中发现了脑膨出（RIA的56.7%，UIA的39.1%）。它们在前交通动脉（ACoA）、后交通动脉（PCoA）和分叉动脉瘤中更常见（均<0.05），并且与破裂相关。RIA的脑膨出比UIA的更大（2.73±1.28mm对2.06±1.07mm，P=0.009）。有脑膨出的IA表现出更大的尺寸、更不规则的形状、更高的纵横比（AR）、瘤顶率（SR）、瘤颈比（BN）、血流方向改变率（HWR）以及更低的瘤颈处壁面切应力标准差（NWSS）、瘤体壁面切应力平均值（TAWSS）、振荡剪切指数（OSI）（均<0.05）。SR是最强的破裂预测因素（曲线下面积[AUC]=0.718，SR>1.3144）。ACoA处的动脉瘤（比值比[OR]=8.812，95%置信区间[CI]：2.455 - 31.634）、PCoA处的动脉瘤（OR = 6.376，CI：2.094 - 19.414）和高SR（OR = 2.738，CI：0.98 - 7.651）是显著的破裂危险因素。PCoA（OR = 2.261，CI：0.759 - 6.739）和SR（OR = 4.683，CI：1.937 - 11.324）独立预测脑膨出形成。