梁丰齐铁伟李竹浩王猛王丽琴李凡滢杨毅兵欧斯奇黄正松

高分辨磁共振血管壁成像在评估颅内动脉瘤中的初步应用☆

梁丰*齐铁伟*李竹浩△王猛△王丽琴△李凡滢*杨毅兵*欧斯奇*黄正松*

目的 探讨高分辨磁共振血管壁成像（high-resolusion magnetic resonance vessel wall imaging，HR-VWI）评估颅内动脉瘤的可行性。方法根据动脉瘤是否破裂，将接受HR-VWI检查的颅内动脉瘤分为破裂组（n=12）和未破裂组（n=88），对比两组动脉瘤的部位、大小、瘤颈宽度、高/颈比（aspect ratio，AR）、子囊和瘤壁强化等级。以动脉瘤是否破裂为因变量，以上各因素为自变量进行单因素和多因素Logistic回归分析。未破裂动脉瘤中，对症状性亚组（n=8）和无症状亚组（n=80）进行对比分析。结果破裂组的动脉瘤大小（t=2.187，P= 0.031）、AR（t=3.164，P=0.002）、子囊比例（P=0.012）和瘤壁强化分级（P＜0.001）大于未破裂组。多因素Logistic回归提示瘤壁强化等级是破裂动脉瘤的独立危险因素（P=0.002）。未破裂动脉瘤中，症状性亚组瘤壁强化分级（P＜0.001）和AR（t=3.939，P＜0.001）大于无症状亚组。结论破裂动脉瘤中HR-VWI瘤壁强化分级高于未破裂动脉瘤，症状性未破裂动脉瘤存在瘤壁强化现象。有必要获得瘤壁的组织学标本，与HR-VWI结果对照分析，进一步研究瘤壁强化的机制和意义。

高分辨磁共振 血管壁成像 颅内动脉瘤

【Abstract】Objective The present study was to investigate the feasibility of use of high resolution magnetic resonance vessel wall imaging（HR-VWI）in evaluation of intracranial aneurysms.MethodsWe prospectively collected data from patients who had intracranial aneurysms and received HR-VWI scan before surgical treatment or conservative treatment.Aneurysms were divided into ruptured group（n=12）and unruptured group（n=88）.Aneurysm site，size，neck，aspect ratio（AR），daughter sac and aneurysmal wall enhancement scale were analyzed in both groups.Univariate and multivariate Logistic regression were performed to evaluate the risk factors of aneurysm rupture.Subgroup analysis was also performed to study symptomatic and asymptomatic unruptured aneurysms.Results Aneurysm size（t=2.187，P= 0.031），AR（t=3.164，P=0.002），incidence of daughter sac（P=0.012）and aneurysmal wall enhancement scale（P＜0.001）were higher in ruptured aneurysm group.Multivariate Logistic regression showed that aneurysmal wall enhancement scale was the only independent risk factor of ruptured aneurysms（P=0.002）.Subgroup analysis showed aneurysm wall enhancement scale（P＜0.001）and AR（t=3.939，P＜0.001）were higher in symptomatic unruptured aneurysms.Conclusion Aneurysm wall enhancement on HR-VWI is more frequently seen in ruptured aneurysms and symptomatic unruptured aneurysms.Histological study is needed for better understanding of the mechanism of aneurysm wall enhancement.

【Key words】High-resolusion magnetic resonance Vessel wall imaging Intracranial aneurysm

判断颅内动脉瘤是否破裂对治疗决策至关重要。目前主要通过CT和腰椎穿刺术确诊。CT应用最广，但有辐射，且少量出血时CT可能出现假阴性结果。腰椎穿刺术敏感性最高，但为有创性检查，且穿刺的损伤可能导致假阳性结果。高分辨磁共振血管壁成像（high-resolusion magnetic resonance vessel wall imaging，HR-VWI）通过黑血成像的方法，突出病变血管壁在增强扫描时的强化现象，具有无创、无辐射、分辨率高的特点，近年来开始用于颅内血管疾病的研究［1］，但在动脉瘤的研究中尚处于起步阶段［2］。……