大脑前动脉A1-A2夹角与前交通动脉瘤发生与破裂的相关性研究

发布时间：2018-06-21 06:39

本文选题：大脑前动脉 + Al优势征　；参考：《浙江大学》2015年硕士论文

【摘要】：目的：探讨大脑前动脉A1-A2段夹角与前交通动脉(anterior communicating artery, ACoA)动脉瘤的发生与破裂的关系。方法：回顾性分析64例前交通动脉瘤及随机选取的同期188例非前交通动脉瘤的影像学资料；利用MSCTA夹角测量工具测量A1-A2段夹角(外侧夹角),记录并比较前交通动脉瘤与非前交通动脉瘤、前交通动脉瘤破裂组与非破裂组之间A1-A2夹角及角度差；A1段形态上分为A1段优势型(A1优势征),A1均衡型；动脉瘤依瘤体指向分为前上型、前下型、后上型、后下型及复杂型；动脉瘤依瘤体在前交通复合体(anterior communicating artery complexus,ACoAC)位置分左偏型、右偏型、中央型。结果：①A1段形态：前交通动脉瘤组,A1段优势型36例(56.3%),左侧A1段优势型28例(43.8%),右侧A1段优势型8例(12.5%)非前交通动脉瘤组,A1段优势型60例(31.9%),左侧A1段优势型39例(20.7%),右侧A1优势型21例(11.2%)。前交通动脉瘤组较非前交通动脉瘤组A1段优势发生率高(x2=11.99,P=0.001),左侧A1段优势发生率高(x2=12.95,P＝0.001),右侧A1段优势发生率相当(x2=0.083,P=0.821)；②A1优势发生情况：左侧A1优势共67例(26.6%),右侧A1优势共29例(11.5%),左侧A1优势较右侧A1优势发生率高(x2=11.87,P=0.000)；③前交通动脉瘤指向：前上型28例,前下型28例,后上型5例,后下型3例,复杂型0例；④A1-A2夹角及角度差：A1均衡型：前交通动脉瘤组,左偏型13例,平均夹角(94.4±15.4)°；右偏型8例,平均夹角(95.9±13.1)°；中央型7例,两侧平均夹角(102.1±26.0)°；21例非中央型前交通动脉瘤平均角度差(22.4±15.8)°；非前交通动脉瘤组,共128例,左侧夹角(123.9±18.8)°,右侧夹角(121.6±18.7)°,平均夹角(122.7±18.4)°,平均角度差(5.8±4.3)°；A1均衡型中,前交通动脉瘤组较非前交通动脉瘤组瘤侧A1-A2夹角变小(t=-5.450, P=0.000; t=-3.838, P=0.000),角度差变大(t＝9.954,P=0.000),即使是中央型前交通动脉瘤也较非前交通动脉瘤组A1-A2夹角小(t=-2.820,P=0.006)；A1优势型：前交通动脉瘤组,共36例,平均夹角(98.8±18.0)°；左侧优势28例,平均夹角(100.5±17.9)°；右侧优势8例,平均夹角(93.0±18.4)°；非前交通动脉瘤组,共60例,平均夹角(118.8±19.1)°；左侧优势39例,平均夹角(122.5±19.3)°；右侧优势21例,平均夹角(111.8±17.0)°；A1优势型中,不论总体还是左侧优势或右侧优势,,前交通动脉瘤组较非前交通动脉瘤组瘤侧A1-A2夹角变小(t=-5.077, P=0.000; t=-4.769, P=0.000; t=-2.602,P=0.015)；⑤A1-A2夹角及角度差：A1均衡型：破裂组,左偏型6例,平均夹角(99.3±10.1)°；右偏型6例,平均夹角(93.4±14.5)°；中央型6例,两侧平均夹角(106.2±25.9)°；12例非中央型前交通动脉瘤破裂型平均角度差(22.1±16.8)°；非破裂组,左偏型6例,平均夹角(96.8±17.8)°；右偏型3例,平均夹角(105.9±4.4)°；中央型1例,两侧平均夹角77.5°；9例非中央型前交通动脉瘤平均角度差(20.1±19.0)°；A1均衡型前交通动脉瘤中,破裂组较非破裂组瘤侧A1-A2夹角及角度差均无明显变化(P0.05)；A1优势型前交通动脉瘤,破裂组,共23例,平均夹角(101.2±18.5)°；左侧优势18例,平均夹角(102.1±18.4)°；右侧优势5例,平均夹角(97.8±20.8)°；非破裂组,共13例,平均夹角(94.6±16.9)°；左侧优势10例,平均夹角(97.5±17.5)°；右侧优势3例,平均夹角(85.1±13.1)°；A1优势型前交通动脉瘤中,不论总体还是左侧优势或右侧优势,破裂组较非破裂组A1-A2夹角均无明显变化(P0.05)。结论：前交通动脉瘤的发生与大脑前动脉A1段优势有关,且具有A1优势征者前交通动脉瘤的发生率明显增高；A1优势征左侧较右侧发生率高；大脑前动脉A1-A2夹角及角度差可协助预测前交通动脉瘤的发生,且较小的A1-A2夹角与较大的角度差更容易发生前交通动脉瘤,但无法评估前交通动脉瘤的破裂出血。
[Abstract]:Objective: To investigate the relationship between the angle of A1-A2 segment of anterior cerebral artery and the occurrence and rupture of anterior communicating artery (ACoA) aneurysms.
Methods: the imaging data of 64 anterior communicating artery aneurysms and 188 non anterior communicating aneurysms were retrospectively analyzed. The angle of A1-A2 segment (lateral angle) was measured by MSCTA angle measuring tool, and the anterior communicating artery aneurysm and non anterior communicating artery aneurysm, the A1-A2 clip between the anterior communicating artery aneurysm rupture group and the non rupture group were recorded and compared. Angle and angle difference; A1 segment is divided into A1 segment dominant (A1 dominance) and A1 equilibrium; aneurysms are divided into anterior, anterior, posterior, posterior, posterior and complex, and aneurysm in the anterior communicating complex (anterior communicating artery Complexus, ACoAC), left partial, right deviation, central type.
Results: A1 segment morphology: anterior communicating artery aneurysm group, A1 segment dominant type 36 cases (56.3%), left A1 segment dominant 28 cases (43.8%), right A1 segment dominant 8 cases (12.5%) non anterior communicating artery aneurysm group, A1 segment dominant 60 cases (31.9%), left A1 segment dominant 39 cases (20.7%), and right A1 dominant 21 cases (11.2%). Anterior communicating artery aneurysm group was more than non anterior communicating artery aneurysm. The dominant incidence of A1 segment was high (x2=11.99, P=0.001), and the incidence of left A1 segment was high (x2=12.95, P = 0.001), and the incidence of the right A1 segment was equal (x2=0.083, P=0.821), and the occurrence of A1 superiority was 67 cases (26.6%) on the left A1 superiority and 29 cases (11.5%) with the right A1 superiority. (3) anterior communicating artery aneurysm point: 28 cases of anterior upper type, 28 cases of anterior and lower type, 5 cases of posterior upper type, 3 cases of posterior inferior type and 0 case of complex type; (4) A1-A2 angle and angle difference: A1 equilibrium type: anterior communicating artery aneurysm group, left deviation 13 cases, average angle (94.4 + 15.4) degree, right deviation 8 cases, average angle of angle (95.9 + 13.1), average angle of central type, 102.1 + 26. (102.1 + 26.) 0); 21 cases of non central anterior communicating artery aneurysm average angle difference (22.4 + 15.8); non anterior communicating artery aneurysm group, 128 cases, left angle (123.9 + 18.8) degrees, right angle (121.6 + 18.7) degrees, average angle (122.7 + 18.4) degrees, average angle difference (5.8 + 4.3) degrees, A1 equilibrium, anterior communicating artery aneurysm group is more than non anterior communicating aneurysm group tumor side A1-A2 The angle became smaller (t=-5.450, P=0.000; t=-3.838, P=0.000), and the angle difference was larger (t = 9.954, P=0.000). Even the central anterior communicating artery aneurysm was smaller than the non anterior communicating artery group (t=-2.820, P=0.006); A1 dominant type: anterior communicating artery aneurysm group, 36 cases, the average angle (98.8 + 18), 28 cases with the left advantage, and the average angle of 100.5 +. 17.9); 8 cases on the right side, average angle (93 + 18.4); non anterior communicating artery aneurysm group, 60 cases, average angle (118.8 + 19.1) degrees, left advantage 39 cases, average angle (122.5 + 19.3) degree, right dominance 21, average angle (111.8 + 17) degrees; A1 dominance, no matter overall or left superiority or right side superiority, anterior communicating artery aneurysm group The A1-A2 angle of the tumor side of the aneurysm group was smaller (t=-5.077, P=0.000; t=-4.769, P=0.000; t=-2.602, P=0.015); (5) A1-A2 angle and angle difference: A1 equilibrium type: rupture group, left partial type 6 cases, average angle (99.3 + 10.1) degree; right deviation 6 cases, average angle (93.4 + 14.5) degrees; central type 6 cases, average angle of both sides (106.2 + 25.9) degrees; 1 The average angle difference between 2 cases of non central anterior communicating artery aneurysm was (22.1 + 16.8) degrees, the non rupture group, the left partial type 6 cases, the mean angle (96.8 + 17.8) degrees, the right partial type 3 cases, the average angle (105.9 + 4.4) degrees, the 1 central type and the average angle 77.5 degrees in the two sides; the average angle difference of the non central anterior communicating artery aneurysm (20.1 +) degrees in 9 cases, and the A1 balance type forward. In the aneurysm, there was no obvious change in the A1-A2 angle and angle difference between the ruptured group and the non rupture group (P0.05); the A1 predominant anterior communicating artery aneurysm and the rupture group were 23 cases, the average angle (101.2 + 18.5) degrees, the left advantage 18 cases, the mean angle (102.1 + 18.4) degrees, the right right potential 5 cases, the average angle (97.8 + 20.8) degrees, and the non rupture group, 13 cases, mean, average 13 cases, mean average. The angle (94.6 + 16.9); the left advantage 10 cases, the average angle (97.5 + 17.5) degrees, the right advantage 3 cases, the average angle (85.1 + 13.1) degrees, A1 predominant anterior communicating artery aneurysm, no matter overall or left superiority or right side superiority, there was no significant change in the angle of A1-A2 in the rupture group compared with the non rupture group (P0.05).
Conclusion: the occurrence of anterior communicating artery aneurysm is related to the predominant A1 segment of the anterior cerebral artery, and the incidence of anterior communicating artery aneurysm with A1 dominance is significantly higher; the incidence of the left side of the A1 advantage sign is higher than that on the right side. The angle and angle difference of the anterior cerebral artery can help to predict the occurrence of the anterior communicating aneurysm, and the smaller A1-A2 angle and the larger angle are larger. Angle difference is more likely to occur in anterior communicating artery aneurysms, but it can not evaluate the rupture and bleeding of anterior communicating artery aneurysms.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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