颅内动脉瘤破裂MSCTA相关因素分析

发布时间：2018-05-04 15:32

本文选题：颅内动脉瘤 + 体层摄影术　；参考：《青海大学》2012年硕士论文

【摘要】：目的：对颅内动脉瘤破裂与多层螺旋CT血管造影（MSCTA）相关因素进行分析，预测动脉瘤破裂的风险。方法：回顾性收集2010年4月-2012年2月在青海大学附属医院影像中心48例自发性蛛网膜下腔出血的患者及18例未出现蛛网膜下腔出血的患者行MSCTA均诊断为颅内动脉瘤，男性30例，女性36例，男：女=0.83：1，，年龄30-72岁，平均年龄52.76±11.48岁。所有患者均通过Philips Brillance16排及256层螺旋CT进行颅内MSCTA扫描（1）16排CT扫描条件为管电压120KV,管电流300mA，层厚0.8mm，层距1mm，螺距1，矩阵512x512，造影剂注射速度为4.0-4.2ml/s，总量约60-80ml（2）256层CT扫描条件为管电压120KV，管电流250mA，层厚0.9mm，层距0.5，螺距0.825，矩阵512x512，扫描时注药速度5.0ml/s，总量40-50ml；患者仰卧位，双手于身体两侧，右手臂接注射针，嘱患者放松，进行定位像扫描，取示踪点于主动脉弓，设置触发阈值为120HU，然后选取主动脉弓至颅顶为扫描范围，当主动脉弓取点CT值达到120HU时，自动扫描，产生的重建图像传送到Extended Brilliance Workspace2.0（16排）、4.5（256层）工作站处理，在后处理工作站上测量动脉瘤的各项参数、部位、形态特征等，比较它们在破裂动脉瘤与未破裂动脉瘤中的差异。结果：（1）66例患者共发现动脉瘤78个，其中256层有10例患者13个动脉瘤，其余在16排；未破裂动脉瘤30个,动脉瘤长径10mm的26个，破裂动脉瘤48个，10mm的41个，其中有4个有子囊；40-65岁之间的45个，40岁的10个，65岁的11个；（2）动脉瘤位于血管分叉处的共45个，其中32个发生破裂，13个未破裂；位于血管未分叉处的33个，其中破裂的16个，未破裂的17个，血管分叉处与未分叉处动脉瘤破裂比较差异有统计学意义（X2=4.122，P0.05）；（3）通过排除，对49个动脉瘤进行瘤体长短、瘤颈测量并瘤体长/瘤颈、瘤体宽/瘤颈宽比值进行比较，破裂与未破裂组分为所有的动脉瘤组（ALL）及动脉瘤长径10mm组，在ALL及长径10mm中：瘤体长、短径及瘤颈宽在两组中的差异没有统计学意义（P0.05）,破裂组与未破裂组瘤体长/瘤颈宽比值为2.13±0.83、1.63±0.51，两者差异有统计学意义（t=2.375，P0.05）,破裂组与未破裂组瘤体宽/瘤颈宽比值为1.63±0.66，1.29±0.38，两组差异有统计学差异（t=2.103，P0.05）；在动脉瘤长径10mm中：破裂组与未破裂组瘤体长/瘤颈比值为1.93±0.59、1.54±0.31，两组差异有统计学差异（t=2.634，P0.05）,而破裂组与未破裂组瘤体宽/瘤颈宽比值为1.49±0.51、1.23±0.30，两组差异没有统计学差异（t=1.945，P0.05）。结论：动脉瘤发生部位、动脉瘤体长径与瘤颈宽之比、动脉瘤体宽径与瘤颈宽之比是动脉瘤可能破裂的危险因素，且差异有统计学意义。
[Abstract]:Objective: to analyze the related factors of intracranial aneurysm rupture and multislice spiral CT angiography (MSCTA) to predict the risk of aneurysm rupture. Methods: from April 2010 to February 2012, 48 patients with spontaneous subarachnoid hemorrhage and 18 patients without subarachnoid hemorrhage in the imaging center of the affiliated Hospital of Qinghai University were examined for intracranial aneurysms diagnosed by MSCTA, including 30 males. 36 cases were female (male: 0.83: 1), aged 30 to 72 years, with an average age of 52.76 卤11.48 years. All patients underwent intracranial MSCTA scan with Philips Brillance16 slice and 256-slice spiral CT. The CT scan conditions were as follows: tube voltage 120 kV, tube current 300 Ma, slice thickness 0.8 mm, pitch 1, matrix 512 x 512, contrast media injection rate 4.0-4.2 ml / s, total CT scanning condition about 60-80ml(2)256 slice. For voltage 120kV, current 250 Ma, layer thickness 0.9 mm, pitch 0.5, pitch 0.825, matrix 512x512, injection speed 5.0 ml / s, total 40-50 ml, patient supine position, With both hands on both sides of the body, the right arm was followed by a needle injection, and the patient was told to relax, scan with a localization image, trace points to the aortic arch, set a trigger threshold of 120 HU. then select the aortic arch to the top of the skull as the scanning range. When the CT value of aortic arch reached 120HU, the reconstructed image was transferred to the Extended Brilliance Workspace2.0(16 row 4.5 / 256) workstation. The parameters, position and morphological features of aneurysm were measured on the post processing workstation. To compare their differences between ruptured and unruptured aneurysms. Results A total of 78 aneurysms were found in 66 patients with 1 / 66 cases, including 10 patients with 13 aneurysms in 256-layer, 30 unruptured aneurysms, 26 aneurysms with long diameter 10mm and 41 ruptured aneurysms with 10 mm long diameter aneurysms. Of these, 4 had 45 cysts between 40 and 65 years of age, 10 patients aged 40 to 65 years old, 11 patients aged 65 years old, 45 aneurysms located at the branches of blood vessels, 32 of them ruptured, 13 of them unruptured, and 33 of them were located at unbroken vessels, of which 16 were ruptured. There were significant differences in rupture of aneurysms between unruptured and unruptured aneurysms (X24.122 / P0.05). Through exclusion, 49 aneurysms were compared in tumor length, tumor neck length / neck length, tumor width / tumor neck width ratio. Ruptured and unruptured components were all aneurysm group (ALL) and aneurysm long diameter 10mm group, in ALL and long diameter 10mm: tumor length, There was no significant difference in short diameter and neck width between the two groups (P 0.05). The ratio of tumor length to neck width in ruptured group and unruptured group was 2.13 卤0.83n 1.63 卤0.51.The difference was statistically significant. The ratio of tumor width to neck width in ruptured group and unruptured group was 1.63 卤0.66n1.29 卤0.38, respectively. The ratio of tumor length to neck in ruptured group and unruptured group was 1.93 卤0.59 卤1.54 卤0.31, there was statistical difference between the two groups, and the ratio of tumor width to neck width in ruptured group and unruptured group was 1.49 卤0.51g / 1.23 卤0.30.The difference between the two groups was statistically significant (t = 2.103, P 0.05), and the ratio between ruptured group and unruptured group was 1.49 卤0.51g / 1.23 卤0.30, and the ratio between ruptured group and unruptured group was 1.49 卤0.51g / 1.23 卤0.30. There was no statistical difference between the two groups. Conclusion: the location of aneurysm, the ratio of length to width of aneurysm and the ratio of width of artery to width of neck are the risk factors of possible rupture of aneurysm, and the difference is statistically significant.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.2;R743

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