颈内动脉瘤头颅CT血管造影血流动力学参数和形态学参数与颈内动脉瘤破裂的相关性

Correlation of hemodynamic parameters and morphological parameters of internal carotid aneurysm head CT angiography and rupture of internal carotid aneurysm

目的探讨头颅CT血管造影血流动力学参数和形态学参数与颈内动脉瘤破裂的相关性。方法选择2016年5月至2021年5月濮阳市人民医院收治的82例颈内动脉瘤患者为研究对象,根据患者颈内动脉瘤是否发生破裂分为破裂组(n=32)和未破裂组(n=50)。采用单因素和多因素logistic回归分析颈内动脉瘤破裂的危险因素,并绘制受试者操作特征(ROC)曲线,评估危险因素对颈内动脉瘤破裂的预测价值。结果患者的性别、年龄、吸烟史、饮酒史、高血压史、动脉瘤数目、瘤体宽度、瘤体垂直高度、瘤体直径、瘤颈宽度及动脉瘤的表面平均压力(PA)、标准化PA、最大压力(PM)、标准化PM、平均壁面剪切力(WSSA)、标准化WSSA、壁面剪切力最大值(WSSM)与颈内动脉瘤破裂无关(P>0.05),动脉瘤的最长径、动脉瘤的体颈比值(AR)、动脉瘤体宽径/瘤颈宽径比值、标准化WSSM(NWSSM)、剪切力震荡指数(OSI)、低剪切力面积比值、平均壁面剪切梯度与颈内动脉瘤破裂有关(P<0.05)。Logistic回归分析结果显示,AR、动脉瘤体宽径/瘤颈宽径比值、NWSSM、OSI均是颈内动脉瘤破裂的危险因素(P<0.05)。ROC曲线显示,AR、动脉瘤体宽径/瘤颈宽径比值、NWSSM、OSI预测颈内动脉瘤破裂的最佳截断值分别为1.4700、1.5300、0.3900、0.0032,灵敏度分别为79.64%、75.62%、90.24%、85.49%,特异度分别为86.37%、89.46%、64.79%、79.86%,曲线下面积分别为0.813、0.791、0.894、0.851。结论AR、动脉瘤体宽径/瘤颈宽径比值、NWSSM、OSI均是影响颈内动脉瘤破裂的危险因素,且对颈内动脉瘤破裂的发生具有较好的预测价值。

Objective To investigate the correlation between hemodynamic parameters and morphological parameters of cranial CT angiography and rupture of internal carotid aneurysm.Methods A total of 82 patients with internal carotid aneurysm admitted to Puyang People′s Hospital from May 2016 to May 2021 were selected as the research objects.The patients were divided into ruptured group(n=32)and unruptured group(n=50)according to whether the internal carotid aneurysm ruptured.The univariate and multivariate logistic regression was used to analyze the risk factors of internal carotid aneurysm rupture,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of risk factors for internal carotid aneurysm rupture.Results The gender,age,smoking history,drinking history,hypertension history,aneurysm number of patients and the tumor width,tumor vertical height,tumor diameter,tumor neck width,pressure average(PA)on aneurysm surface,normalized PA on aneurysm surface,pressur maximum(PM)on aneurysm surface,normalized PM on aneurysm surface,wall shear stress average(WSSA),normalized WSSA,wall shear stress maximum(WSSM)were not related to the rupture of internal carotid aneurysms(P>0.05);while the longest diameter,aspect ratio(AR),aneurysm body-diameter/aneurysm-neck width-diameter ratio,normalized WSSM(NWSSM),oscillatory shear index(OSI),low shear area ratio and wall shear stress gradient average of aneurysms were related to the rupture of internal carotid aneurysms(P<0.05).The results of logistic regression analysis showed that the AR,aneurysm body-diameter/aneurysm-neck width-diameter ratio,NWSSM and OSI of aneurysms were the risk factors of rupture of internal carotid aneurysm(P<0.05).The ROC curve showed that the best cut-off values of AR,aneurysm body-diameter/aneurysm-neck width-diameter ratio,NWSSM,and OSI for predicting internal carotid aneurysm rupture were 1.4700,1.5300,0.3900 and 0.0032,respectively;the sensitivity were 79.64%,75.62%,90.24%and 85.49%,respectively;the specificity were 86.37%,89.46%,64.79%,79.86%;and the area under the curve were 0.813,0.791,0.894,0.851,respectively.Conclusion AR,aneurysm body-diameter/aneurysm-neck width-diameter ratio,NWSSM,OSI are risk factors of the rupture of internal carotid aneurysm,and which have good predictive value for the occurrence of internal carotid aneurysm rupture.