摘要
目的探讨研究大脑中动脉分叉部动脉瘤及周边血管形态学因素和动脉瘤破裂的相关性,用来评估大脑中动脉分叉部未破裂动脉瘤远期破裂风险,为临床决策手术治疗或者随访观察提供依据。方法使用飞利浦DSA行动脉瘤所在侧颈动脉旋转造影,得出动脉瘤及其周围血管的3D-DSA模型,通过PACS影像学系统测量得到动脉瘤最大高度、垂直高度、瘤颈长度、动脉瘤角、血流角、大脑中动脉M1段长度、M2间夹角、动脉瘤高宽比。通过使用单变量和多变量分析,分别研究这些参数和动脉瘤破裂的相关性。结果我们搜集了2011年～2014年在鼓楼医院脑血管病治疗中心收治的大脑中动脉瘤患者101例,剔除7例M1段动脉瘤和4例M2段动脉瘤,剔除16例开颅夹闭未行DSA造影患者,剩余74例大脑中动脉分叉部动脉瘤(42例破裂、32例未破裂)进入研究序列,所有病例均已行DSA全脑血管造影。我们得到结果证实破裂组动脉瘤较未破裂组动脉瘤具有较大高宽比、较小的动脉瘤颈长度、较小的M2夹角。通过统计学分析,我们得到结果证实较小的动脉瘤颈长度、较小的M2夹角和较大的高宽比和大脑中动脉分叉部动脉瘤破裂有相关性。结论通过研究大脑中动脉分叉部动脉瘤的形态及周边血管的形态学参数,我们确定大脑中动脉分叉部动脉瘤高宽比、动脉瘤颈长度、M2夹角与动脉瘤破裂相关。这些参数涵盖了大脑中动脉分叉部动脉瘤自身形态因素、动脉瘤周边血管自身形态参数。
Objective To investigate the correlation between the morphological factors of bifurcation aneurysms of middle cerebral artery(MCA) and peripheral blood vessels and rupture of aneurysms, and to evaluate the long-term rupture risk of unruptured aneurysms of bifurcation of MCA, and to provide basis for clinical decisionmaking, surgical treatment or follow-up observation.Methods The 3D-DSA model of the aneurysm and its surrounding vessels was obtained by rotational angiography of the carotid artery on the side of the aneurysm with Philips DSA.The maximum height,vertical height,neck length,aneurysm angle,blood ? ow angle,M1 segment length of middle cerebral artery,angle between M2 and aspect ratio of the aneurysm were measured by PACS imaging system.The correlation between these parameters and aneurysm rupture was studied by univariate and multivariate analysis.Results From 2011 to 2014, 101 patients with middle cerebral artery aneurysms were enrolled in the Cerebrovascular Disease Treatment Center of Gulou Hospital. Seven M1 and four M2 aneurysms were excluded.Sixteen patients without DSA were excluded.The remaining 74 patients with bifurcation aneurysms of middle cerebral artery(42 ruptured and 32 unruptured) were enrolled in the study.DSA angiography was performed in all cases.The results show that ruptured aneurysms have larger aspect ratio, smaller neck length and smaller M2 angle than unruptured aneurysms.Statistical analysis showed that smaller neck length, smaller angle of M2 and larger aspect ratio were correlated with rupture of middle cerebral artery bifurcation aneurysms.Conclusion By studying the morphology of the bifurcated aneurysms of the middle cerebral artery and the morphological parameters of the peripheral vessels, we determined that the ratio of height to width of the bifurcated aneurysms of the middle cerebral artery, the length of the aneurysm neck and the angle of M2 were related to the rupture of the aneurysms.These parameters cover the morphological factors of the bifurcation aneurysms of the middle cerebral artery and the peripheral vessels of the aneurysms.
引文
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