Application of high-resolution magnetic resonance imaging in the rupture risk assessment of unruptured intracranial aneurysms
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摘要:
目的探究高分辨磁共振（HR-MRI）成像在颅内未破裂动脉瘤破裂风险评估中的应用效果。 方法回顾性分析2017年1月~2020年12月我院收治经过三维数字减影血管造影技术诊断为颅内动脉瘤的88例患者（101个动脉瘤）的临床资料，根据动脉是否破裂分为破裂组（n=30，35个动脉瘤）、未破裂组（n=58，66个动脉瘤），并将未破裂组分为强化亚组（n=22，26个动脉瘤）和未强化亚组（n=36，40个动脉瘤），所有患者均行HR-MRI成像，观察各组动脉瘤特征。 结果HR-MRI成像检查与数字减影血管造影诊断结果相比，准确率为79.55%。破裂组强化率明显高于未破裂组，差异有统计学意义（P < 0.05）。破裂组与未破裂组动脉瘤位置、动脉瘤大小、是否为宽颈动脉瘤、瘤体体率比较差异无统计学意义（P>0.05）；破裂组有子囊、体颈比≥2的比例明显高于未破裂组，差异有统计学意义（P < 0.05）。强化组与未强化组动脉瘤位置、动脉瘤大小、是否为宽颈动脉瘤比较差异无统计学意义（P>0.05）；强化组有子囊、体颈比≥2、瘤体体率≥2的比例明显高于未强化组，差异有统计学意义（P < 0.05）。 结论HR-MRI成像在颅内未破裂动脉瘤破裂风险评估中有良好应用效果，瘤体破裂风险与瘤壁强化有一定关系，影响瘤壁强化的因素有子囊情况及体颈比、瘤体体率等动脉瘤形态学特征。 Abstract:ObjectiveTo explore the application effect of high-resolution magnetic resonance imaging (HR-MRI) in the rupture risk assessment of unruptured intracranial aneurysms. MethodsThe clinical data of 88 patients (101 aneurysms) diagnosed as intracranial aneurysms by three-dimensional digital subtraction angiography in the hospital were retrospectively analyzed between January 2017 and December 2020. According to whether the artery was ruptured, the patients were divided into ruptured group (n=30, 35 aneurysms) and unruptured group (n=58, 66 aneurysms), and the patients in the unruptured group were classified as enhanced subgroup (n=22, 26 aneurysms) and unenhanced subgroup (n=36, 40 aneurysms). All patients underwent HR-MRI imaging to observe the characteristics of aneurysms in each group. ResultsCompared with the diagnostic result of digital subtraction angiography, the accuracy rate of HR-MRI imaging examination was 79.55%. The enhancement rate of ruptured group was significantly higher than that of unruptured group (P < 0.05). There was no statistical significance in aneurysm location, aneurysm size, presence or absence of wide-necked aneurysm or size ratio between ruptured group and unruptured group (P>0.05). The ratios of ascus and aspect ratio≥2 in ruptured group were significantly higher than those in unruptured group (P < 0.05). The differences in the location of aneurysm, the size of aneurysm, and presence or absence wide-necked aneurysm were not significant between enhanced group and unenhanced group (P>0.05). The ratios of ascuss, aspect ratio≥2, and size ratio≥2 were significantly higher in enhanced group than those in unenhanced group (P < 0.05). ConclusionHR-MRI imaging has a good application effect in the rupture risk assessment of unruptured intracranial aneurysms. The risk of tumor rupture has a certain relationship with the enhancement of the tumor wall. And the factors affecting the enhancement of the tumor wall are ascus status and morphological characteristics of aneurysm such as aspect ratio and size ratio. -
图 1 HR-MRI图像
A：3D磁共振血管造影，V4动脉瘤左侧后前位；B：3D磁共振血管造影，V4动脉瘤右侧后前位；C：T2WI呈低信号血管流空；D：T1WI+C示瘤壁强化均匀；E：3D磁共振血管造影，右侧C4段动脉瘤；F：T1WI，虚线内为等信号血栓影；G：T1WI，虚线内为低信号新月形流空影；H：T1WI+C示动脉瘤壁明显强化.
Figure 1. HR-MRI images.
表 1 颅内动脉瘤瘤体破裂与瘤壁强化的关系
Table 1. Relationship between tumor rupture and tumor wall enhancement of intracranial aneurysms (n)
组别 瘤体数 强化 未强化 强化率(%) 破裂组 35 35 0 100.00 未破裂组 66 26 40 39.39 χ2 35.122 P < 0.001 
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表 2 破裂组与未破裂组动脉瘤形态学特征比较
Table 2. Comparison of morphological characteristics of aneurysms between ruptured group and unruptured group
病变特征 破裂组(35个动脉瘤) 未破裂组(66个动脉瘤) χ2 P 动脉瘤位置 0.011 0.917 前循环 20 37 后循环 15 29 动脉瘤大小(mm) 0.008 0.929 < 5 14 27 ≥5 21 39 宽颈动脉瘤 1.987 0.159 是 28 44 否 7 22 子囊 30.676 < 0.001 有 26 12 无 9 54 AR 6.576 0.010 < 2 19 52 ≥2 16 14 SR 0.788 0.375 < 2 18 40 ≥2 17 26 AR：体颈比；SR：瘤体体率.
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表 3 强化组与未强化组动脉瘤形态学特征比较
Table 3. Comparison of morphological characteristics of aneurysms between enhanced group and unenhanced group
病变特征 强化组(26个动脉瘤) 未强化(40个动脉瘤) χ2 P 动脉瘤位置 0.523 0.470 前循环 16 21 后循环 10 19 动脉瘤大小(mm) 0.703 0.402 < 5 9 18 ≥5 17 22 宽颈动脉瘤 0.127 0.722 是 18 26 否 8 14 子囊 22.564 ＜0.001 有 12 0 无 14 40 AR 15.967 ＜0.001 < 2 14 38 ≥2 12 2 SR 6.016 0.014 < 2 11 29 ≥2 15 11
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