MRA技术对颅内动脉瘤破裂出血的预测效能及评估术后载瘤动脉通畅性的价值

Predictive Efficacy of MRA in Intracranial Aneurysm Rupture and Hemorrhage and the Value of Evaluating the Patency of the Parent Artery after Operation

【目的】探究磁共振血管成像(MRA)技术对颅内动脉瘤破裂出血的预测效能及评估术后载瘤动脉通畅性的价值。【方法】选取2017年10月至2020年5月本院收治的121例颅内动脉瘤患者,根据动脉瘤破裂出血情况将其分为破裂组(动脉瘤破裂出血,n=45)和未破裂组(动脉瘤未破裂,n=76)。比较两组MRA技术参数[剪切力震荡指数(OSI)、平均壁面剪切力(WSSA)、平均壁面剪切力梯度(WSSGA)、标准化表面最大剪切力(NWSSM)、低剪切力面积比值(LSAR)、标准化收缩期动脉瘤的表面平均压力(NPA)、标准化一个心动周期内的动脉瘤表面最大压力(NPM)],分析颅内动脉瘤破裂出血的影响因素、MRA技术参数对颅内动脉瘤破裂出血的预测价值,并随访1年,以经数字减影血管造影(DSA)为标准,评价MRA技术对术后载瘤动脉通畅性的评估价值。【结果】两组WSSA、NPA、NPM比较,差异无统计学意义(P>0.05);破裂组瘤体长度、宽度、动脉瘤体颈比值(AR)、高度与载瘤动脉直径比值(SR)、OSI、WSSGA、LSAR高于未破裂组,NWSSM低于未破裂组(P<0.05)。Logistic回归分析显示,OSI、WSSGA、LSAR、NWSSM是颅内动脉瘤破裂出血的重要影响因素(P<0.05);OSI、WSSGA、LSAR、NWSSM联合预测颅内动脉瘤破裂出血的曲线下面积(AUC)为0.861,敏感度为80.49%,特异度为84.21%,明显高于四者单独预测;Kappa一致性分析,MRA技术与DSA检查评估术后载瘤动脉通畅性一致性较高(P<0.05)。【结论】MRA技术测定OSI、WSSGA、LSAR、NWSSM等参数联合预测颅内动脉瘤破裂出血价值较高,且可较好评估术后载瘤动脉通畅性。

【Objective】To investigate the predictive efficacy of magnetic resonance angiography(MRA)in the rupture and hemorrhage of intracranial aneurysms and to evaluate the patency of the parent artery.【Methods】A total of 121 patients with intracranial aneurysms treated in our hospital from October 2017 to may 2020 were selected and divided into rupture group(aneurysm rupture and bleeding,n=45)and unruptured group(aneurysm unruptured,n=76)according to the situation of aneurysm rupture and bleeding.The MRA parameters of the two groups were compared[oscillatory shear index(OSI),wall shear stress averaged(WSSA),wall shear stress gradient averaged(WSSGA),normalized surface wall shear stress maximum(NWSSM),low shear stress area ratio(LSAR),normalized surface pressure averaged(NPA)of systolic aneurysms,normalized one cardiac cycle pressure maximum(NPM)],the influencing factors of intracranial aneurysm rupture and hemorrhage and the predictive value of MRA parameters for intracranial aneurysm rupture and hemorrhage were analyzed.The patients were followed up for 1 year.The value of MRA in evaluating the patency of tumor bearing artery was evaluated by DSA.【Results】There was no significant difference in WSSA,NPA and NPM between the two groups(P>0.05);The tumor length,width,AR,SR,OSI,WSSGA and LSAR in the ruptured group were higher than those in the unruptured group,and NWSSM was lower than those in the unruptured group(P<0.05).Logistic regression analysis showed that OSI,WSSGA,LSAR and NWSSM were important influencing factors of intracranial aneurysm rupture and hemorrhage(P<0.05);The AUC of OSI,WSSGA,LSAR and NWSSM in predicting intracranial aneurysm rupture and hemorrhage was 0.861,the sensitivity was 80.49%,and the specificity was 84.21%,which was significantly higher than that predicted by the four alone;Kappa consistency analysis showed that MRA and DSA were highly consistent in evaluating the patency of the parent artery(P<0.05).【Conclusion】The combination of OSI,WSSGA,LSAR,NWSSM and other parameters measured by MRA is of high value in predicting the rupture and hemorrhage of intracranial aneurysms,and can better evaluate the patency of the parent artery after operation.