颅内镜像动脉瘤形态学及血流动力学参数与其破裂的关系

Morphological and haemodynamic parameters of intracranial mirror aneurysms in relation to their ruptures

目的探讨颅内镜像动脉瘤形态学及血流动力学参数与其破裂的关系。方法去回顾性分析2017年1月至2022年6月新疆医科大学第一附属医院神经外科收治的30例(共60个动脉瘤)颅内镜像动脉瘤患者的临床资料。收集患者头颅CT血管成像(CTA)的原始数据,导入Mimicus建模,选择3-MATIC光滑模型,使用Fluent软件划分流体域并行血流动力学仿真计算。根据三维CTA数据测量和计算颅内动脉瘤的瘤颈宽度等11个形态学参数。对比镜像动脉瘤破裂侧与非破裂侧的形态学和血流动力学参数,并进行多因素logistic回归分析,以确定动脉瘤破裂的独立风险因素。结果与颅内镜像动脉瘤未破裂侧比较,破裂侧的动脉瘤高度[M(Q_(1),Q_(3))][4.59(3.80,6.67)mm对比2.73(2.31,3.82)mm]、最大高度[5.94(4.39,7.28)mm对比3.44(2.49,5.06)mm]、最大径[5.50(3.63,7.00)mm对比3.42(2.82,4.32)mm]、瘤颈宽度[(4.78±1.52)mm对比(3.64±1.23)mm]、纵横比[1.16(1.00,1.86)对比0.99(0.70,1.23)]、尺寸比[2.18(1.42,3.23)对比1.24(0.97,1.87)]、高宽比[1.03(0.79,1.50)对比0.85(0.59,1.12)]均较大,差异均具有统计学意义(均P<0.05);而两侧流人角、不规则形状、载瘤动脉的平均直径、瓶颈因子、壁面压力、壁剪切应力、流速的差异均无统计学意义(均P≥0.05)。多因素logistic回归模型分析结果显示,动脉瘤的高度、最大高度、最大径、瘤颈宽度、纵横比、尺寸比和高宽比均非动脉瘤破裂的独立影响因素(均P>0.05)。结论颅内动脉瘤的高度、最大高度、最大径、瘤颈宽度、纵横比、尺寸比、高宽比均可能与其破裂有关。

Objective To explore the relationship between morphological and hemodynamic parameters of intracranial mirror aneurysms and their ruptures.Methods The clinical data of 30 patients(60 aneurysms in total)with intracranial mirror aneurysms admitted to the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University from January 2017 to June 2022 were retrospectively analyzed.Raw data from patients'cranial CT angiography(CTA)were collected,imported into Mimicus modelling,and a 3-MATIC smooth model was selected for parallel hemodynamic simulation calculations using Fluent to delineate the fluid domain.Eleven morphological parameters,including the aneurysm neck width of intracranial aneurysms,were measured and calculated based on the 3D CTA data.Morphological and haemodynamic parameters of the ruptured side of the mirror image aneurysm were compared with those of the unruptured side,and multivariate logistic regression analyses were performed to identify independent risk factors for aneurysm rupture.ResultsCompared with the unruptured side of the intracranial mirror aneurysm,the aneurysm height on the ruptured side[M(Q_(1),Q_(3))]was[4.59(3.80,6.67)mm]vs.[2.73(2.31,3.82)mm],the maximum height was[5.94(4.39,7.28)mm]vs.[3.44(2.49,5.06)mm],the maximum diameter was[5.50(3.63,7.00)mm]vs.[3.42(2.82,4.32)mm],the neck width was 4.78±1.52 mm us.3.64±1.23 mm,the aspect ratio was[1.16(1.00,1.86)]vs.[0.99(0.70,1.23)],the height ratio was[2.18(1.42,3.23)]us.[1.24(0.97,1.87)],height-towidth ratio was[1.03(0.79,1.50)]us.[0.85(0.59,1.12)],and all those differences were significant(all P<0.05).However,there was no statistically significant difference in the inflow angle,irregular shape,average diameter of the parent artery,bottleneck factor,wall pressure,wall shear stress,or flow velocity between the two sides(all P≥0.05).The results of the multivariate logistic regression model analysis showed that the aneurysm height,maximum height,maximum diameter,neck width,aspect ratio,size ratio,or height-to-width ratio was not independent influencing factors of aneurysm rupture(all P>0.05).Conclusion The height,maximum height,maximum diameter,aneurysm neck width,aspect ratio,size ratio,and height-to-width ratio of intracranial aneurysms may be related to their ruptures.