高分辨MRI颅内动脉瘤瘤壁环形强化的临床意义

Clinical significance of circumferential aneurysmal wall enhancement of intracranial aneurysms in high-resolution magnetic resonance imaging

目的探讨高分辨MRI（HR-MRI）中颅内动脉瘤瘤壁环形强化（CAWE）的临床意义。方法回顾性分析2014年10月至2015年7月收治的41例行钆剂增强3.0 T HR-MRI检查的颅内动脉瘤患者的影像及临床资料;由两名有经验的神经血管影像医师独立阅片,确定患者的颅内动脉瘤瘤壁是否出现CAWE。其中颅内不稳定动脉瘤患者25例,颅内稳定动脉瘤患者16例。对两名医师诊断CAWE结果的一致性进行kappa检验;比较两组患者颅内动脉瘤影像特征CAWE、个数、位置、大小等以及性别、年龄、吸烟史、饮酒史、高血压、糖尿病等,临床危险因素组间比较采用χ^2检验。结果 41例患者共发现颅内动脉瘤47个,其中颅内不稳定动脉瘤29个、颅内稳定动脉瘤18个;两名有经验的神经血管影像医师诊断CAWE结果的一致性较好（κ=0.828,95%CI：0.668～0.989）;颅内不稳定动脉瘤的CAWE明显较颅内稳定动脉瘤多,差异有统计学意义[75.9%（22/29）比33.3%（6/18）;χ^2=8.341,P=0.004];颅内不稳定动脉瘤患者的年龄〈60岁者较颅内稳定动脉瘤者多,差异有统计学意义[68.0%（17/25）比31.2%（5/16）;χ^2=5.299,P=0.021];而两组颅内动脉瘤均个数、位置、大小以及包括性别、吸烟史、饮酒史、高血压、糖尿病的差异均无统计学意义（P〉0.05）。结论 CAWE多明显见于颅内不稳定动脉瘤,能将症状性、形态改变及破裂的颅内动脉瘤与颅内稳定动脉瘤鉴别。

Objective To investigate the clinical significance of circumferential aneurysmal wall enhancement（ CAWE） in high-resolution magnetic resonance imaging. Methods The imaging and clinical data of 41 patients with intracranial aneurysm underwent gadolinium-enhanced 3. 0 T HR-MRI from October2014 to July 2015 were analyzed retrospectively. Two experienced neurovascular radiologists read the vascular neuroimagings independently and determined whether the intracranial aneurysm walls of the patents had CAWE. Twenty-five patients had unstable intracranial aneurysms and 16 had stable intracranial aneurysms.The consistency of the diagnostic results of the 2 radiologists was evaluated by the Kappa test. The CAWE,number,location,size and the imaging features of intracranial aneurysms,as well as gender,age,smoking history,drinking history,hypertension and diabetes of clinical risk factors of the patients in both groups were compared. The comparison between groups was conducted by using the chi-square test.Results A total of 4 7 intracranial aneurysms were detected in 4 1 patients,including 2 9 unstable intracranial aneurysm s（ a unstable aneurysm group） and 1 8 stable intracranial aneurysms（ a stable aneurysm group）. The consistency of CAWE results diagnosed by 2 experienced neurovascular radiologists was better（ κ = 0. 828; 95% CI 0. 668-0. 989）. CAWE of the unstable intracranial aneurysms was significantly more than those of the stable intracranial aneurysms. There was significant difference（ 75. 9%[22 /29] vs.33. 33%[6 /18]; χ^2= 8. 341,P = 0. 004）. The age of the patients with unstable intracranial aneurysm was younger than 60 years; it was more than those with stable intracranial aneurysm. There was significant difference（ 68%[17/25]vs. 31. 25%[5/16]; χ^2= 5. 299,P = 0. 021）,while there were no significant differences in the imaging features,including the number,location,size,as well as the clinical risk factors,including gender,sm oking history,drinking history,hypertension,and diabetes between the 2 groups（ P〉0. 05）.Conclusion CAWE is significantly more common in unstable intracranial aneurysms. It can differentiate the symptomatic,morphological changes of ruptured intracranial aneurysms between the stable intracranial aneurysms.