脑动脉硬化斑块与脑动脉瘤的CTA特征分析

Analysis of characteristics of cerebral artery atherosclerotic plaques and cerebral aneurysms using CTA images

目的探讨脑动脉硬化(AS)斑块与脑动脉瘤(CA)的CT血管造影(CTA)特征。方法回顾性分析2015年12月至2018年12月初步诊断AS、CA的735例病人的影像学资料,所有病人均经DSA确诊。结果735例中,单纯AS斑块216例,共检出747个斑块;单纯CA共50例,检出53个动脉瘤;CA合并AS斑块143例,检出512个斑块,218个动脉瘤;无CA、AS斑块326例。AS斑块病人CA发生率(39.8%,143/359)明显高于无AS斑块病人(13.3%,50/376;P<0.05);而且,AS斑块病人囊状动脉瘤发生率(48.5%,50/103)较无AS斑块病人明显增高(39.6%,143/361;P<0.05)。512个斑块中,软斑块113个,硬斑块205个,混合斑块194个;颈内动脉分叉处近端(包括颈内动脉后交通段、眼动脉段、海绵窦段)共284个,而其中硬斑块比例(77.1%,158/205)和混合斑块比例(50.5%,98/194)均明显高于软斑块比例(24.8%,28/113;P<0.05)。颈内动脉分叉处近端斑块平均数量[(4.30±0.90)个/例]明显高于其他部位斑块平均数量[(2.51±1.02)个/例;P<0.05]。结论AS斑块和囊状CA在颅内动脉发生的空间位置特征相同,AS斑块促进囊性CA形成,两者的形成与血流动力学、脑血管结构相关。

Objective To investigate the characteristics of cerebral atherosclerotic plaques(CAS-P)and cerebral aneurysms(CA)using CTA images.Methods The imaging data of 735 patients who were initially diagnosed with cerebral atherosclerosis and CA from December 2015 to December 2018 were retrospectively analyzed.All patients were difinitely diagnosed by DSA.Results Of 735 patients,216 patients suffered from simple CAS-P with 747 plaques,50 from simple CA with 53 aneurysms,143 from CA combined with CAS-P with 512 plaques and 218 aneurysms,and 326 had no CA and CAS-P.The rate of CA in patients with CAS-P(39.8%,143/359)was significantly higher than that(13.3%,50/376)of patients without CAS-P(P<0.05);and the rate of saccular aneurysms in patients with CAS-P(48.5%,50/103)was significantly higher than that(39.6%,143/361)of patients without CAS-P(P<0.05).Of 512 plaques,113 were soft plaques,205 hard plaques,and 194 mixed plaques;the posterior communicating,the ophthalmic artery and the cavernous sinus segments of the internal carotid artery had 284 plaques of which the proportions of hard plaques(77.1%,158/205)and mixed plaques(50.5%,98/194)were significantly higher than the proportion of soft plaques(24.8%,28/113;P<0.05).The average plaque number of the posterior communicating,the ophthalmic artery and the cavernous sinus segments of the internal carotid artery(4.30±0.90)was significantly higher than the average plaque number of other intracranial arteries[(2.51±1.02);P<0.05].Conclusions CAS-P and cystic CA have the same spatial location characteristics in intracranial arteries.CAS-P promotes the formation of cystic CA,and their formations are related to hemodynamics and cerebrovascular structures.