賴湘 張文波 葉敏 范偉雄 劉曉平

[摘要] 目的 研究高分辨磁共振瘤壁成像（HR-VWI）在顱內(nèi)未破裂動(dòng)脈瘤（UIA）中的應(yīng)用。 方法 將梅州市人民醫(yī)院神經(jīng)外科從2018年1月至2020年10月收治的擬行開(kāi)顱手術(shù)夾閉或介入栓塞的UIA患者39例納入研究。對(duì)所有受試者均開(kāi)展HR-VWI檢查，分析病變部位、病灶大小、瘤高與頸寬比（AR）、子囊、瘤壁強(qiáng)化情況。對(duì)所有受試者臨床癥狀進(jìn)行破裂風(fēng)險(xiǎn)評(píng)估，并根據(jù)癥狀分為高破裂風(fēng)險(xiǎn)組10例和低破裂風(fēng)險(xiǎn)組29例。采集所有受試者的各項(xiàng)基線資料并進(jìn)行對(duì)比。采用多因素Logistic回歸分析明確UIA患者動(dòng)脈瘤破裂的危險(xiǎn)因素。 結(jié)果 高破裂風(fēng)險(xiǎn)組高血壓及頭痛例數(shù)占比均明顯高于低破裂風(fēng)險(xiǎn)組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。高破裂風(fēng)險(xiǎn)組病灶大小及子囊、瘤壁強(qiáng)化例數(shù)占比均高于低破裂風(fēng)險(xiǎn)組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。經(jīng)多因素Logistic回歸分析可知，高血壓、頭痛、病灶大小、瘤壁強(qiáng)化均是UIA患者動(dòng)脈瘤破裂的危險(xiǎn)因素（OR>1，P<0.05）。 結(jié)論 HR-VWI應(yīng)用于UIA的診斷中具有較高的價(jià)值，且可為動(dòng)脈瘤破裂提供一定的輔助預(yù)測(cè)作用，值得臨床重點(diǎn)關(guān)注。

[關(guān)鍵詞] 顱內(nèi)未破裂動(dòng)脈瘤;高分辨磁共振;瘤壁成像;危險(xiǎn)因素

[中圖分類(lèi)號(hào)] R651? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）24-0103-04

Application of high-resolution magnetic resonance vascular wall imaging in unruptured intracranial aneurysms

LAI Xiang1? ?ZHANG Wenbo1? ?YE Min1? ?FAN Weixiong2? ?LIU Xiaoping1

1.Department of Neurosurgery， Meizhou People's Hospital in Guangdong Province， Meizhou? ?514031， China; 2.Department of Magnetic Resonance， Meizhou People's Hospital in Guangdong Province， Meizhou? ?514031，China

[Abstract] Objective To investigate the application of high-resolution magnetic resonance vascular wall imaging（HR-VWI）in unruptured intracranial aneurysms（UIA）. Methods Thirty-nine UIA patients admitted to the Department of Neurosurgery of Meizhou People's Hospital from January 2018 to October 2020 who were scheduled to undergo craniotomy or interventional embolization were included. HR-VWI examinations were performed on all patients to analyze the lesion location， lesion size， aspect ratio（AR）， ascus， and aneurysmal wall enhancement. The clinical symptoms of all patients were assessed for the risk of rupture. They were divided into the high rupture risk group with 10 patients and the low rupture risk group with 29 patients according to the symptoms. Baseline data of all patients were collected and compared. Multivariate Logistic regression analysis was conducted to clarify the risk factors of aneurysm rupture in UIA patients. Results The proportions of hypertension and headache in the high rupture risk group were significantly higher than those in the low rupture risk group，the difference was statistically significant（P<0.05）. The lesion size and proportions of patients with ascus and aneurysmal wall enhancement in the high rupture risk group were higher than those in the low rupture risk group，the difference was statistically significant（P<0.05）. Multivariate Logistic regression analysis showed that hypertension， headache， lesion size， and aneurysmal wall enhancement were risk factors for aneurysm rupture in UIA patients（OR>1， P<0.05）. Conclusion HR-VWI has high value in the diagnosis of UIA and certain auxiliary predictive effect for aneurysm rupture. Attention should be paid to it in clinical practice.