颅内未破裂动脉瘤出现破裂相关症状风险的Nomogram预测模型

Nomogram Prediction Model for the Risk of Rupture-Related Symptoms for Unruptured Intracranial Aneurysms

目的基于高分辨率MRI血管壁成像特征建立预测未破裂动脉瘤出现破裂相关症状风险的Nomogram模型。资料与方法回顾性分析2019年1月—2021年10月哈尔滨工业大学附属黑龙江省医院收治的68例未破裂动脉瘤患者,包括症状性动脉瘤20例、无症状动脉瘤48例,比较两组的高分辨率MRI血管壁成像特征及一般临床因素,筛选症状性动脉瘤相关的独立预测因素,构建Nomogram评分模型,采用受试者工作特征曲线评价其预测性能。结果症状性动脉瘤与无症状动脉瘤组间动脉瘤大小、不规则形态、壁强化、瘤高颈比及壁增强指数比较,差异均有统计学意义(t/χ^(2)=15.236、8.594、15.088、25.966、34.389,P均<0.05);多因素Logistic回归分析显示,瘤高颈比及壁增强指数是症状性动脉瘤的独立预测因子(P=0.033、0.044);Nomogram评分模型的预测能力曲线下面积为0.94,最佳分数截断值为0.2,敏感度为0.92,特异度为0.90。结论基于高分辨MRI影像特征建立的预测未破裂动脉瘤发生破裂相关症状风险的Nomogram模型性能良好、使用简便、适用性强,可以帮助临床医师对未破裂动脉瘤进行分层管理,制订个体化治疗及随访方案。

Purpose To establish a Nomogram model to predict the risk of rupture-related symptoms for unruptured aneurysms based on high-resolution MRI imaging features.Materials and Methods Sixty-eight patients with unruptured aneurysm in Heilongjiang Provincial Hospital,Harbin Institute of Technology from January 2019 to October 2021 were retrospectively analyzed,including 20 symptomatic aneurysms and 48 asymptomatic aneurysms,the characteristics of high-resolution MRI imaging features and general clinical factors were compared between the two groups,and independent predictive factors of symptomatic aneurysm were screened to construct a Nomogram model,ROC curve was drawn to evaluate its predictive performance.Results There were significant differences in aneurysm size,irregular morphology,wall enhancement,tumor aspect ratio and wall enhancement index between patients with and without symptomatic aneurysms(t/χ^(2)=15.236,8.594,15.088,25.966,34.389;all P<0.05).Multivariate Logistic regression analysis showed that aspect ratio and wall enhancement index were independent predictors of symptomatic aneurysm(P=0.033,0.044).The area under curve of this Nomogram model was 0.94,the optimal cut-off value,sensitivity and specificity were 0.2,0.92 and 0.90,respectively.Conclusion This Nomogram model predicting the risk of rupture-related symptoms for unruptured aneurysms based on high-resolution MRI imaging features has good performance,convenience and applicability,which can help clinicians stratified management of unruptured aneurysms and develop individualized treatment and follow-up plans.