本文關(guān)鍵詞： CTA 大腦中動(dòng)脈 動(dòng)脈瘤　出處：《吉林大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景： 盡管已有很多學(xué)者研究了顱內(nèi)動(dòng)脈瘤，，但是在動(dòng)脈瘤破裂的危險(xiǎn)因素間的多重相關(guān)性的研究仍然不多。近幾十年來，許多研究者通過研究動(dòng)脈瘤的形態(tài)學(xué)參數(shù)來預(yù)測動(dòng)脈瘤破裂的風(fēng)險(xiǎn)，但是仍沒有找到可以確切預(yù)測動(dòng)脈瘤破裂風(fēng)險(xiǎn)的獨(dú)立參數(shù)。從這些研究中，我們已經(jīng)了解了很多關(guān)于動(dòng)脈瘤的知識(shí)。在很多研究人員中，動(dòng)脈瘤的形態(tài)被認(rèn)為是一個(gè)潛在的顱內(nèi)動(dòng)脈瘤破裂的因素。本研究致力于研究已被多名學(xué)者定義的不同形態(tài)學(xué)參數(shù)對(duì)動(dòng)脈瘤破裂風(fēng)險(xiǎn)的預(yù)測。本文中動(dòng)脈瘤形態(tài)的多個(gè)參數(shù)都顯示與動(dòng)脈瘤的破裂風(fēng)險(xiǎn)有相關(guān)性。在很多已經(jīng)被認(rèn)為可能預(yù)測動(dòng)脈瘤破裂風(fēng)險(xiǎn)的形態(tài)學(xué)參數(shù)中，結(jié)果顯示這些形態(tài)學(xué)參數(shù)可以作為預(yù)測動(dòng)脈瘤破裂風(fēng)險(xiǎn)的因素。本研究通過研究動(dòng)脈瘤患者CTA圖像，比較不同形態(tài)學(xué)參數(shù)在預(yù)測動(dòng)脈瘤破裂風(fēng)險(xiǎn)上的差異及統(tǒng)計(jì)學(xué)意義。 研究目的： 通過CT血管造影（CTA）研究大腦中動(dòng)脈(MCA)動(dòng)脈瘤的形態(tài)學(xué)特征。 材料與方法： 本研究搜集2011年1月至2012年1月到吉林大學(xué)第一醫(yī)院就診的患者，共62例患者，其中26例患者中，發(fā)現(xiàn)27個(gè)未破裂動(dòng)脈瘤，另外36例患者，發(fā)現(xiàn)36個(gè)破裂動(dòng)脈瘤。其中11例患者為雙側(cè)大腦中動(dòng)脈動(dòng)脈瘤，其他患者為單發(fā)或多發(fā)動(dòng)脈瘤。只有發(fā)生在大腦中動(dòng)脈的動(dòng)脈瘤計(jì)入統(tǒng)計(jì)，其他部位動(dòng)脈瘤不計(jì)入統(tǒng)計(jì)。除囊狀動(dòng)脈瘤外，梭形與霉菌性動(dòng)脈瘤不計(jì)入本研究。醫(yī)院計(jì)算機(jī)系統(tǒng)PACS（圖片存檔和通信系統(tǒng)）記錄了每個(gè)病人的醫(yī)療記錄，包括既往病史、影像學(xué)檢查、治療過程及結(jié)果。該系統(tǒng)通過回顧性分析為我們提供有用的信息。本研究通過CTA工作站后處理獲得動(dòng)脈瘤的形態(tài)學(xué)參數(shù)，并統(tǒng)計(jì)分析動(dòng)脈瘤形態(tài)參數(shù)對(duì)動(dòng)脈瘤破裂風(fēng)險(xiǎn)評(píng)估的意義。 結(jié)果： 統(tǒng)計(jì)發(fā)現(xiàn)，動(dòng)脈瘤的各種形態(tài)學(xué)參數(shù)在評(píng)價(jià)預(yù)測動(dòng)脈瘤破裂風(fēng)險(xiǎn)上均有顯著性差異。 1.動(dòng)脈瘤尺寸比SR作為唯一一個(gè)預(yù)測動(dòng)脈瘤破裂風(fēng)險(xiǎn)的獨(dú)立指標(biāo)，也是最重要的形態(tài)學(xué)參數(shù)（p0.001，AUC0.78）。 2.動(dòng)脈瘤其他形態(tài)學(xué)參數(shù)也可以預(yù)測其破裂風(fēng)險(xiǎn)，如最大動(dòng)脈瘤高度Hmax(p≤0.001, AUC0.78),、深度Hpr(p≤0.001, AUC0.77),、高寬比AR (p=0.002,AUC0.73)及動(dòng)脈瘤體積(p≤0.001, AUC0.75)。然而，Logistic回歸分析顯示這些形態(tài)參數(shù)不能作為預(yù)測動(dòng)脈瘤破裂的獨(dú)立指標(biāo)。 3.動(dòng)脈瘤（包括破裂及未破裂動(dòng)脈瘤）好發(fā)于女性，右側(cè)多于左側(cè)。動(dòng)脈瘤患者年齡大多分布在51-60歲，未破裂動(dòng)脈瘤平均年齡55.59歲，破裂動(dòng)脈瘤平均年齡52.56歲。 結(jié)論： 基于動(dòng)脈瘤多種形態(tài)學(xué)參數(shù)的研究，CTA是預(yù)測動(dòng)脈瘤破裂風(fēng)險(xiǎn)的重要影像學(xué)方法。尺寸比SR是最重要且最有意義的一個(gè)形態(tài)學(xué)參數(shù)。
[Abstract]:Background: Although many scholars have studied intracranial aneurysms, the multiple correlation between the risk factors of aneurysm rupture has not been studied much in recent decades. Many researchers have studied the morphological parameters of aneurysms to predict the risk of aneurysm rupture, but no independent parameters have been found to predict the risk of aneurysm rupture. We've learned a lot about aneurysms. Among many researchers. The morphology of the aneurysm is considered to be a potential cause of intracranial aneurysm rupture. This study is devoted to the prediction of the risk of aneurysm rupture by different morphological parameters that have been defined by many scholars. Multiple parameters of the aneurysm are associated with the risk of rupture of the aneurysm. In many morphological parameters that have been suggested to predict the risk of rupture of the aneurysm. The results showed that these morphological parameters could be used as a predictor of the risk of aneurysm rupture. In this study, CTA images of aneurysms were studied. To compare the difference and statistical significance of different morphological parameters in predicting the risk of aneurysm rupture. Objectives of the study: The morphological characteristics of MCA aneurysms in middle cerebral artery were studied by CT angiography (CTAA). Materials and methods: This study collected 62 patients from January 2011 to January 2012 in the first Hospital of Jilin University, of which 27 unruptured aneurysms were found in 26 patients. 36 ruptured aneurysms were found in 36 patients, 11 of whom were bilateral middle cerebral artery aneurysms. Other patients are single or multiple aneurysms. Only aneurysms that occur in the middle cerebral artery are counted, but not elsewhere. Except for cystic aneurysms. Fusiform and mildew aneurysms were excluded from this study. The hospital computer system PACS (Picture Archiving and Communication system) recorded the medical records of each patient, including past medical history and imaging examinations. The system provides us with useful information through retrospective analysis. The morphological parameters of aneurysms were obtained by CTA workstation postprocessing. The significance of the morphological parameters of aneurysm to the risk of aneurysm rupture was analyzed statistically. Results: According to statistics, the morphological parameters of aneurysm were significantly different in predicting the risk of aneurysm rupture. 1. Aneurysm size ratio (SR), as the only independent index to predict the risk of aneurysm rupture, is also the most important morphological parameter (p 0.001 AUC 0.78). 2. Other morphological parameters of aneurysms can also predict the risk of rupture, such as maximum aneurysm height Hmax(p 鈮

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