高分辨磁共振瘤壁成像在颅内未破裂动脉瘤中的应用

Application of high-resolution magnetic resonance vascular wall imaging in unruptured intracranial aneurysms

目的研究高分辨磁共振瘤壁成像(HR-VWI)在颅内未破裂动脉瘤(UIA)中的应用。方法将梅州市人民医院神经外科从2018年1月至2020年10月收治的拟行开颅手术夹闭或介入栓塞的UIA患者39例纳入研究。对所有受试者均开展HR-VWI检查,分析病变部位、病灶大小、瘤高与颈宽比(AR)、子囊、瘤壁强化情况。对所有受试者临床症状进行破裂风险评估,并根据症状分为高破裂风险组10例和低破裂风险组29例。采集所有受试者的各项基线资料并进行对比。采用多因素Logistic回归分析明确UIA患者动脉瘤破裂的危险因素。结果高破裂风险组高血压及头痛例数占比均明显高于低破裂风险组,差异有统计学意义(P<0.05)。高破裂风险组病灶大小及子囊、瘤壁强化例数占比均高于低破裂风险组,差异有统计学意义(P<0.05)。经多因素Logistic回归分析可知,高血压、头痛、病灶大小、瘤壁强化均是UIA患者动脉瘤破裂的危险因素(OR>1,P<0.05)。结论HR-VWI应用于UIA的诊断中具有较高的价值,且可为动脉瘤破裂提供一定的辅助预测作用,值得临床重点关注。

Objective To investigate the application of high-resolution magnetic resonance vascular wall imaging(HR-VWI)in unruptured intracranial aneurysms(UIA).Methods Thirty-nine UIA patients admitted to the Department of Neurosurgery of Meizhou People's Hospital from January 2018 to October 2020 who were scheduled to undergo craniotomy or interventional embolization were included.HR-VWI examinations were performed on all patients to analyze the lesion location,lesion size,aspect ratio(AR),ascus,and aneurysmal wall enhancement.The clinical symptoms of all patients were assessed for the risk of rupture.They were divided into the high rupture risk group with 10 patients and the low rupture risk group with 29 patients according to the symptoms.Baseline data of all patients were collected and compared.Multivariate Logistic regression analysis was conducted to clarify the risk factors of aneurysm rupture in UIA patients.Results The proportions of hypertension and headache in the high rupture risk group were significantly higher than those in the low rupture risk group,the difference was statistically significant(P<0.05).The lesion size and proportions of patients with ascus and aneurysmal wall enhancement in the high rupture risk group were higher than those in the low rupture risk group,the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that hypertension,headache,lesion size,and aneurysmal wall enhancement were risk factors for aneurysm rupture in UIA patients(OR>1,P<0.05).Conclusion HR-VWI has high value in the diagnosis of UIA and certain auxiliary predictive effect for aneurysm rupture.Attention should be paid to it in clinical practice.