高分辨MRI下颅内未破裂动脉瘤瘤壁环形强化的临床意义

Clinical significance of aneurysm wall ring enhancement demonstrated on high resolution MRI for unruptured intracranial aneurysms

目的探讨高分辨磁共振成像（HRMRI）下颅内未破裂动脉瘤瘤壁环形强化（CAWE）的临床意义。方法选取2014年10月至2015年6月收治的接受钆剂增强HRMRI检测的颅内未破裂动脉瘤患者28例，其中有症状患者13例（警示性头痛8例，患侧动眼神经麻痹5例），无症状患者15例。2名影像科医师独立阅片，确定是否出现CAWE。结果检测发现28例患者31枚颅内未破裂动脉瘤。根据Kappa一致性检验，2名影像科医师诊断CAWE结果有较高一致性（Kappa=0．7427，95％CI：0．51-0．98）。13例有症状患者14枚动脉瘤中11枚（11／14，78．6％）出现CAWE，15例无症状患者17枚动脉瘤中5枚（5／17。29．4％）出现CAWE，两者间差异有统计学意义（P=-0．0113）。结论钆剂增强HRMRI检测显示有症状颅内未破裂动脉瘤患者CAWE明显较无症状患者多见，提示动脉瘤未来破裂的可能性较高。

Objective To discuss the clinical significance of ring enhancement of unruptured intracranial aneurysm wall demonstrated on high resolution MRI （HR-MRI）. Methods A total of 28 patients with unruptured intracranial aneurysms, who were admitted to authors＇ hospital during the period from October 2014 to June 2015 and received gadolinium-enhanced HR-MRI, were included in this study. Of the 28 patients, 13 were clinically symptomatic, including sentinel headache （n=8） and ipsilateral oculomotor nerve palsy （n=5）, and 15 were asymptomatic. Two radiologists independently reviewed MRI images and determined the presence or absence of aneurysm wall ring enhancement. Results A total of 31 unruptured intracranial aneurysms were detected in 28 patients. Kappa conformance test indicated that the results of aneurysm wall ring enhancement judged by two radiologists were high consistency （kappa=0.74; 95%CI： 0.51-0.98）. Among the 14 intracranial aneurysms observed in 13 symptomatic patients, 11 （11/14, 78.6%） showed the sign of aneurysm wall ring enhancement; while in the 17 intracranial aneurysms found in 15 asymptomatic patients, only 5 （5/17, 29.4% ） displayed the sign of aneurysm wall ring enhancement; the difference between the two groups was statistically significant （P=-0.0113 ）. Conclusion Gadolinium-enhanced HR-MRI can reveal the sign of aneurysm wall ring enhancement more frequently in symptomatic patients than in asymptomatic patients with unruptured intracranial aneurysms, and the presence of this sign suggests that the possibility of aneurysm rupture in the future is relatively high.