CT血管造影预测颅内动脉瘤破裂出血的价值

The value of CT angiography in predicting ruptured intracranial aneurysm hemorrhage

目的探讨CT血管造影(CTA)预测颅内动脉瘤破裂出血的价值。方法回顾性选取四川省简阳市人民医院2019年4月至2022年4月收治的85例颅内动脉瘤患者作为研究对象,分析患者临床资料,根据数字减影血管造影(DSA)检查结果分为无破裂出血组(n=40,颅内动脉瘤无破裂出血)、破裂出血组(n=45,颅内动脉瘤破裂出血)。所有患者入院后均行CTA检查,比较两组患者动脉瘤分布情况(大脑中动脉、大脑后动脉、大脑前动脉、后交通动脉、前交通动脉、椎动脉颅内段、基底动脉),并分析两组患者瘤颈宽度、瘤体长度、入射夹角、动脉瘤体颈比。绘制受试者工作特征曲线(ROC)分析瘤颈宽度、瘤体长度、入射夹角、动脉瘤体颈比对颅内动脉瘤破裂风险的预测价值,确定曲线下面积(AUC)、最佳截断值与敏感度、特异度。经Kappa检验分析CTA与DSA诊断的一致性。结果破裂出血组大脑中动脉瘤、后交通动脉瘤占比分别为26.67%、20.00%,高于无破裂出血组的7.50%、5.00%,差异有统计学意义(P<0.05)。破裂出血组前交通动脉瘤占比为8.89%,低于无破裂出血组的25.00%,差异有统计学意义(P<0.05)。破裂出血组瘤颈宽度、瘤体长度、入射夹角、动脉瘤体颈比高于无破裂出血组,差异有统计学意义(P<0.05)。瘤颈宽度、瘤体长度、入射夹角、动脉瘤体颈比预测颅内动脉瘤破裂出血的AUC分别为0.792、0.803、0.801、0.777。当瘤颈宽度>2.940 mm、瘤体长度>3.100 mm、入射夹角>111.700°、动脉瘤体颈比>1.055时,患者破裂出血风险更高。四项联合预测破裂出血的AUC为0.883。以DSA为金标准,提示CTA诊断颅内动脉瘤破裂出血的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为86.67%、90.00%、88.24%、90.70%、85.71%,与DSA诊断一致性为0.765。结论通过CTA造影检查,可明确患者的动脉瘤分布与瘤颈宽度、瘤体长度、入射夹角、动脉瘤体颈比,对颅内动脉瘤破裂出血风险评估有较高预测价值,且与DSA诊断一致性较好。

Objective To investigate the value of CT angiography(CTA)in predicting ruptured intracranial aneurysm hemorrhage.Methods A total of 85 patients with intracranial aneurysm who were treated in the People's Hospital of Jianyang City from April 2019 to April 2022 were retrospectively selected as the research subjects,and the clinical data of the patients were analyzed.According to the results of digital subtraction angiography(DSA),the patients were divided into non-ruptured hemorrhage group(n=40,no ruptured hemorrhage of intracranial aneurysm)and ruptured hemorrhage group(n=45,ruptured hemorrhage of intracranial aneurysm).All patients underwent CTA examination after admission,and the distribution of aneurysms(middle cerebral artery,posterior cerebral artery,anterior cerebral artery,posterior communicating artery,anterior communicating artery,intracranial vertebral artery,basilar artery)in the two groups was compared,and aneurysm neck width,aneurysm length,incident angle,aneurysm body-to-neck ratio of the two groups were analyzed.Receiver operating characteristic curve(ROC)was drawn to analyze the predictive value of aneurysm neck width,aneurysm body length,incident angle,and aneurysm body-to-neck ratio on the risk of intracranial aneurysm rupture,and determined the area under the curve(AUC),the cut off value and sensitivity and specificity.The consistency of CTA and DSA diagnosis was analyzed by Kappa test.Results The proportions of middle cerebral aneurysm and posterior communicating artery aneurysm in the ruptured hemorrhage group were 26.67% and 20.00% respectively,which were higher than 7.50% and 5.00% of the non-ruptured hemorrhage group,and the differences were statistically significant(P<0.05).The proportion of anterior communicating aneurysm in the ruptured hemorrhage group was 8.89%,which was lower than 25.00% in the non-ruptured hemorrhage group,and the difference was statistically significant(P<0.05).The aneurysm neck width,aneurysm body length,incident angle,and aneurysm body-to-neck ratio in the ruptured hemorrhage group were higher than those in the non-ruptured hemorrhage group,and the differences were statistically significant(P<0.05).The AUC of aneurysm neck width,aneurysm body length,incident angle and aneurysm body-to-neck ratio for predicting intracranial aneurysm rupture and hemorrhage were 0.792,0.803,0.801 and 0.777 respectively.When the aneurysm neck width>2.940 mm,the aneurysm body length>3.100 mm,the incident angle>111.700°,and the aneurysm body-to-neck ratio>1.055,the risk of rupture and bleeding was higher.The AUC of the combination of four indicators predicting ruptured bleeding was 0.883.Taking DSA as the gold standard,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of CTA in diagnosing intracranial aneurysm hemorrhage were 86.67%,90.00%,88.24%,90.70% and 85.71% respectively.The diagnostic consistency was 0.765.Conclusion Through CTA angiography,the distribution of aneurysms,aneurysm neck width,aneurysm body length,the incident angle and the aneurysm body-to-neck ratio can be determined.It has a high predictive value for the risk assessment of intracranial aneurysm rupture and hemorrhage,and has a good consistency with DSA diagnosis.