四维CT血管成像在微小动脉瘤破裂风险因素分析中的应用价值
| 作者: |
1张雪辉,
1左云海,
1季涛
1 青岛市市立医院本部放射科，山东 青岛 266011 |
| 通讯: |
季涛
Email: 2370918791@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2020.05.021 |
摘要
目的：探究四维CT血管成像(four-dimensional CT angiography，4D-CTA)在颅内长径<5 mm的动脉瘤破裂风险因素分析中的应用价值。方法：选取2015年1月至2018年12月于青岛市市立医院连续行心电控4D-CTA检查的颅内动脉瘤236患者作为研究对象，依据动脉瘤是否破裂分为破裂组(144例)和未破裂组(92例)，单因素分析两组患者的临床资料和瘤颈比(aspect ratio，AR)、动脉瘤的大小、动脉瘤的瘤高与载瘤动脉直径之比(size ratio，SR)、入射夹角、异常搏动点，logistic回归分析颅内长径<5 mm的动脉瘤破裂风险因素，并采用受试者工作特征(receiver operating characteristic，ROC)曲线绘制预测模型。结果：单因素分析结果显示家族史、血管分叉处、出现异常搏动点、AR、SR以及入射夹角在破裂组和未破裂组间差异有统计学意义(P<0.05)；logistic回归分析结果显示出现异常搏动点(OR：8.498；95%CI：2.876~28.197)、AR(OR：4.389；95%CI：1.129~18.298)、SR(OR：4.718；95%CI：1.403~16.238)以及入射夹角(OR：1.067；95%CI：1.028~1.879)均为颅内长径<5 mm的动脉瘤破裂的独立危险因素，以此建立的预测模型ROC曲线下面积为0.744(95%CI：0.701~0.795)，截断值为0.542时，模型预测性能较好，准确率为84.38%，敏感度为88.76%，特异度为82.17%，阳性预测值为92.12%，阴性预测值为80.28%。结论：出现异常搏动点、高AR、高SR以及高入射夹角均提示颅内长径<5 mm的动脉瘤具有破裂的风险，4D-CTA作为新的动态检查方法，在发现微小动脉瘤破裂方面具有十分重要的意义。
关键词：
颅内动脉瘤；蛛网膜下腔出血；危险因素
Application value of four-dimensional CT angiography in risk factor analysis for rupture of microaneurysms
CorrespondingAuthor: JI Tao Email: 2370918791@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.05.021
Abstract
Objective: to explore the application value of four-dimensional CT angiography (4D-CTA) in the analysis of risk factors of intracranial aneurysm rupture with length <5 mm. Methods: A total of 236 patients with intracranial aneurysms who underwent continuous cardiac electric control 4D-CTA examination in our hospital from January 2015 to December 2018 were selected as the research objects. According to whether the aneurysm ruptured, they were divided into ruptured group (144 cases) and unruptured group (92 cases). The clinical data, aspect ratio (AR), aneurysm size, ratio of aneurysm height to tumor-bearing artery diameter (SR), incidence angle, pulsation point of the two groups of patients were analyzed by single factor. Logistic regression was used to analyze the risk factors of intracranial aneurysm rupture with length <5 mm, and receiver operating characteristic curve (ROC) was used to draw the prediction model. Results: The results of single factor analysis showed that there were statistical differences in family history, vascular bifurcation, pulsating point, AR, SR and incidence angle between ruptured group and unruptured group (P<0.05). Logistic regression analysis showed pulsating point (OR: 8.498; 95% CI: 2.876–28.197), AR (OR: 4.389; 95%CI: 1.129–18.298), SR (OR: 4.718; 95% CI: 1.403–16.238) and incidence angle (OR: 1.067; 95% CI: 1.028–1.879) were independent risk factors for intracranial aneurysm rupture with a long diameter <5 mm. The area under ROC curve of the prediction model established by this method was 0.744 (95% CI: 0.701–0.795). When the cutoff value was 0.542, the prediction performance of the model was good, the accuracy rate was 84.38%, the sensitivity was 88.76%, the specificity was 82.17%, the positive prediction value was 92.12%, and the negative prediction value was 80.28%. Conclusion: The occurrence of abnormal pulsating point, high AR, high SR, and high incidence angle suggested that aneurysms with intracranial length <5 mm are at risk of rupture. As a new dynamic examination method, 4D-CTA is of great significance in detecting rupture of microaneurysms.
Keywords：
intracranial aneurysm; subarachnoid hemorrhage; risk factor