Willis环形态与颅内动脉瘤发生部位关系的CTA分析

CTA analysis of anatomical variation of the circle of Wills and the site of aneurysm formation

目的采用128层螺旋CT脑血管成像,探讨Willis环形态与哪些部位脑动脉瘤的发生有关。方法回顾性分析1 013例受检者的脑血管CTA资料,根据CTA诊断结果,分为动脉瘤组361例,对照组652例,前者检出的450个动脉瘤按发生部位分为前交通动脉瘤组72例、后交通动脉瘤组168例、颈内动脉瘤组100例、大脑中动脉瘤组58例、其他前循环动脉瘤组18例、后循环动脉瘤组34例。定义Willis环"对称性"及"单侧完整性"两种分型方法。对受检者性别、年龄、动脉瘤发生部位、Willis环分型进行描述性统计,并在各亚组与对照组之间分别进行Willis环不同分型构成比的统计学比较。结果脑动脉瘤各亚组中,以前交通动脉瘤组及大脑中动脉瘤组平均年龄最小,分别为50.35岁、52.49岁,且与平均年龄最大的后交通动脉瘤组(56.65岁)间差异显著(P<0.05)。前交通动脉瘤组与对照组间Willis环对称性分型构成比不同,差异具有统计学意义(P=0.000),其Willis环前部不对称的比例(44.4%)较对照组(12.5%)高;大脑中动脉瘤组与对照组间单侧Willis环完整性分型构成比不同,差异具有统计学意义(P=0.005)。结论 Willis环不对称尤其是前部不对称与前交通动脉瘤的产生有关,单侧Willis环完整性可能影响同侧大脑中动脉瘤的产生。

Objective To investigate the impact of anatomical variation of the Circle of Willis on the incidence of intracranial aneurysms at various locations. Methods 1013 patients who underwent cerebral computed tomography angiography（CTA） were retrospectively divided into aneurysm group with（361） and control group without（652） aneurysms according to the CTA results.The 450 aneurysms in 361 patients were located in the anterior communicating（Aco A,72）, posterior communicating artery（Pco A,168）, internal carotid artery, 100）, middle cerebral artery（MCA, 58）, other sites of the anterior（18） and posterior（34） circle of Willis. Patients＇ gender, age, locations of aneurysms, balanced or partial integral types of Circle of Willis were compared between the aneurysm and control groups. Results The average age of patients with Aco A（50.35 years） and MCA aneurysms（52.49 years）was significantly lower（P〈0.05） than that of Pco A aneurysms（56.65 years）...The incidence of partial integral anterior circle of Willis was significantly（P=0） higher in the patients with Aco A aneurysm（44.4%） than that of control group（12.5%）. There was also significant difference in the ratios of partial integral types of circle of Willis between MCA aneurysm and the control group（P=0.005）. Conclusion Patients with partial integral circle of Willis are more likely to develop ipsilateral Aco A and MCA aneurysms.