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目的探讨破裂与未破裂大脑中动脉动脉瘤(middle cerebral artery aneurysm,MCAA)在容积CT数字减影血管成像(volume CTdigital subtraction angiograhy,VCTDSA)上的形态学差异。资料与方法回顾性分析2007年9月至2010年1月54例55个MCAA VCTDSA表现,根据颅内有无出血分为破裂组和未破裂组,由两名神经放射学医师采用双盲法评价二者形状、大小、瘤颈、载瘤动脉分叉角度、瘤体纵横比(aspect ratio,AP值),比较二者在形态学上的差异。结果破裂组动脉瘤36个(65.45%),其中椎状或半球状15个(41.6%),囊状12个(33.33%),梭状3个(8.33%),球状1个(2.77%),不规则5个(13.88%);未破裂动脉瘤19个(34.55%),其中锥状或半球状11个(57.89%),囊状4个(21.05%),球状4个(21.05%),二者形状分类上有统计学差异(P<0.05)。破裂组动脉瘤瘤壁伴尖角征12个(33.33%):顶壁8个,侧壁4个;瘤样突起6个(16.67%):顶壁4个,侧壁2个;瘤体上小动脉2个(5.56%),伴子瘤3个(8.33%);未破裂组动脉瘤瘤壁伴尖角征2个(10.52%),均位于侧壁,瘤样突出位于侧壁2个(10.52%),伴瘤体上小动脉1个(5.26%),二者差异无明显统计学意义(P>0.05);破裂组与未破裂组长径分别为(6.05±5.85)mm、(4.55±7.10)mm,二者差异无统计学意义(P>0.05)。破裂组与未破裂组载瘤动脉分叉角度分别为(138.70±31.90)°、(144.53±21.81)°,破裂组与未破裂组瘤颈分别为(3.50±2.40)mm、(3.00±1.70)mm,分叉角度及瘤颈二者差异无统计学意义(P>0.05);破裂组与未破裂组动脉瘤AP值分别为1.68±0.83、0.87±0.92,二者差异具有显著统计学意义(P=0.0076),AP值敏感性和特异性分别为69%、71%,AP临界值为1.28。结论破裂与未破裂大脑中动脉分叉处动脉瘤VCTDSA具有形态学差异,二者瘤壁征象、载瘤动脉角度、瘤颈、瘤体长径无明显差异,形状有明显差异,而AP值作为预测动脉瘤破裂风险有一定的诊断价值。
Objective To investigate the morphological differences of volumetric CT digital subtraction angiograhy (VCTDSA) between ruptured and unruptured middle cerebral artery aneurysm (MCAA). Materials and Methods Retrospective analysis from September 2007 to January 2010 54 cases of 55 MCAA VCTDSA performance, according to the presence or absence of intracranial hemorrhage was divided into rupture group and rupture group, by two neuroradiologists double-blind evaluation The shapes, sizes, neoplasms, bifurcation angles of artery and the aspect ratio (AP) of the two groups were compared, and morphological differences were compared. Results There were 36 aneurysms in rupture group (65.45%), including 15 (41.6%) vertebrae or hemispheres, 12 (33.33%) cysts, 3 (8.33% , Irregular 5 (13.88%), unruptured aneurysm 19 (34.55%), including 11 pyramidal or hemispherical (57.89%), 4 cystic (21.05%), 4 spherical (21.05% There was a statistically significant difference in the shape classification (P <0.05). Aneurysm rupture aneurysm wall with sharp angle sign 12 (33.33%): the top 8, the side wall 4; tumor-like protuberance 6 (16.67%): the top 4, 2; 2 (5.56%) of the arterioles and 3 (8.33%) of the accessory tumor, and 2 (10.52%) of the aneurysm wall with no rupture were located on the side wall, 10.52%) and 1 (5.26%) of arteriolar arterioles, there was no significant difference between the two groups (P> 0.05). The long diameter of rupture group and non rupture group were (6.05 ± 5.85) mm and ± 7.10) mm, the difference was not statistically significant (P> 0.05). The bifurcation angles of the artery in the ruptured group and the ruptured group were (138.70 ± 31.90) ° and (144.53 ± 21.81) °, respectively. The tumor neck in rupture group and rupture group were (3.50 ± 2.40) mm and (3.00 ± 1.70) (P> 0.05). The AP values of aneurysm in ruptured group and non-ruptured group were 1.68 ± 0.83 and 0.87 ± 0.92, respectively (P> 0.05), the difference was statistically significant ( P = 0.0076). The sensitivity and specificity of AP values were 69% and 71%, respectively, and the AP threshold was 1.28. Conclusions VCTDSA has a morphological difference between ruptured and unruptured middle cerebral artery bifurcation. There are no significant differences in tumor wall appearance, tumor-bearing artery angle, tumor neck, Predict the risk of aneurysm rupture has a certain diagnostic value.