| 王欣然,胡斌,施昭,张龙江.CT血管成像形态学及血流动力学参数预测颅内动脉瘤经血管内栓塞治疗后复发[J].中国医学影像技术,2025,41(1):9~14 |
| CT血管成像形态学及血流动力学参数预测颅内动脉瘤经血管内栓塞治疗后复发 |
| Morphological and hemodynamic parameters of CT angiography for predicting recurrence of intracranial aneurysms after endovascular embolization |
| 投稿时间：2024-09-02 修订日期：2024-10-29 |
| DOI：10.13929/j.issn.1003-3289.2025.01.003 |
| 中文关键词: 颅内动脉瘤 血流动力学 复发 血管造影术 |
| 英文关键词:intracranial aneurysm hemodynamics recurrence angiography |
| 基金项目:国家自然科学基金(82230068、82102155)。 |
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| 中文摘要: |
| 目的 观察CT血管成像(CTA)形态学及血流动力学参数预测颅内动脉瘤(IA)经血管内栓塞治疗后复发的价值。方法 回顾性收集接受血管内栓塞治疗的205例IA破裂患者,根据随访结果分为复发组(n=35)与非复发组(n=170),比较组间治疗前CTA所示IA形态学及血流动力学参数;采用方差膨胀因子(VIF)判断上述参数之间有无共线性,将无共线性参数纳入单因素及多因素logistic回归分析,筛选颅IA经血管内栓塞治疗后复发的预测因素,构建基于形态学参数(模型1)及联合血流动力学参数(模型2)预测模型。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价模型预测效能。结果 复发组IA最大径、瘤颈宽度、最大高度、最大垂直高度及尺寸比(SR)均大于非复发组(P均＜0.05),而振荡梯度数(GON)小于非复发组(P＜0.05)。瘤颈宽度、SR、瘤颈平面压力、IA内时间平均壁剪切应力(TAWSS)、振荡剪切指数(OSI)及GON均无明显共线性(VIF均＜10);其中,瘤颈宽度、SR及TAWSS均为独立预测因素(P均＜0.05)。模型1、2预测颅IA经血管内栓塞后复发的AUC分别为0.668和0.723,模型2预测效能高于模型1(综合判别改善指数为0.055,P=0.025)。结论 IA CTA形态学联合血流动力学参数可用于预测其经血管内栓塞治疗后复发。 |
| 英文摘要: |
| Objective To investigate the value of morphological and hemodynamic parameters of CT angiography (CTA) for predicting recurrence of intracranial aneurysms (IA) after endovascular embolization. Methods Totally 205 patients with ruptured IA who underwent endovascular embolization were retrospectively collected and divided into recurrence group (n=35) and non-recurrence group (n=170) according to follow-up results after embolization. The morphological and hemodynamic parameters of IA in CTA before treatment were compared between groups. Variance inflation factor (VIF) was used to explore whether there was collinearity between morphological and hemodynamic parameters, and those without collinearity were included in univariate and multivariate logistic regression analysis to screen predictors of recurrence of IA after endovascular embolization. Two prediction models were constructed based on morphological parameters (model 1) and combination with hemodynamic parameters (model 2). Receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of models. Results The maximum diameter, aneurysm neck width, maximum height, maximum vertical height and size ratio (SR) of IA in recurrence group were all higher than those in non-recurrence group (all P＜0.05), while gradient oscillatory number (GON) in recurrence group was lower than that in non-recurrence group (P＜0.05). The neck width, SR, pressure at IA neck plane, intra-aneurysm time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI) and GON had no significant collinearity (all VIF＜10), among which the neck width, SR and TAWSS were all independent predictors (all P＜0.05). AUC of model 1 and model 2 for predicting recurrence of IA after endovascular embolization was 0.668 and 0.723, respectively, which of model 2 was higher than which of model 1 (integrated discrimination improvement index was 0.055, P=0.025). Conclusion CTA morphological parameters combined with hemodynamic parameters of IA could be used to predict its recurrence after endovascular embolization. |
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