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Detection of Ruptured Intracranial Aneurysms and Predicting Aneurysmal Ruptured Probability with Digital Subtraction Computed Tomographic Angiography

Author: LiuYuanZao
Tutor: DiZhaoHua
School: North Sichuan Medical College
Course: Medical Imaging and Nuclear Medicine
Keywords: intracranial aneurysm subarachnoid hemorrhage digitalsubtraction computed tomography angiography digital subtractionangiography three-dimensionmorphology rupture predict risk factors logisticregression
CLC: R732.21
Type: Master's thesis
Year: 2014
Downloads: 3
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Objective: To evaluate the diagnostic performance of64rows digitalsubtraction computed tomographic angiography (DSCTA) to detect rupturedintracranial aneurysms compared with, three-dimensional digital subtractionangiography (3D-DSA), a reference standard.Materials and Methods: This study was approved by the institutionalreview board; written informed consent was obtained. One hundred forty-fourconsecutive patients suspected of having aneurismal subarachnoidhemorrhage were recruited Between January2012and November2013. Allof patients underwent both64-detector digital subtraction computedtomographic angiography and three-dimensional digital subtractionangiography for the detection of intracranial aneurysms. In a dedicated,source images were post-processed to reconstruct three-dimensional imageand measure the aneurysmal size. With3D-DSA findings as the referencestandard, computed tomographic angiograms images were reviewed by twoindependent blinded readers. Sensitivity and specificity of digital subtractionCT angiography in depicting aneurysm were analyzed about a per-patient andper-aneurysm basis. The sensitivity, specificity of digital subtractioncomputed tomographic angiography in depicting aneurysms of differentdiameter (ie,<3mm,≥3mm and<5mm,≥5mm and<10mm,≥10mm)and of aneurysms at different locations in the anterior and posteriorcirculation were calculated. Results: One hundred ninety-nine aneurysms were seen in one hundredforty-four patients. Of those, digital subtraction computed tomographicangiography helped detect196. On a per-aneurysm basis, the sensitivity,specificity, for CT angiography was98.5%,100%, respectively. Foraneurysms smaller than3mm, sensitivity was91.2%. However, thesensitivity and specificity were both100%for aneurysms larger than3mmand all of ruptured intracranial aneurysms.Conclusion: It, sixty-four rows spiral digital subtraction computedtomographic angiography, is an accurate imaging method for the detection ofaneurysms and ever can detect all of the ruptured aneurysms. In addition, it iseffective tool to develop a treatment plan. So it can be used as the primaryscreening method for patients who had aneurismal subarachnoid hemorrhagein the diagnostic routine. Objective: Management strategies for unruptured intracranial aneurysms(UIAs) are controversial. This study aimed to identify surrogate parametersthat highly predict the ruptured Probabilities of small (<5mm) UIAs.Methods: Radiological data were collected from44patients who havetwo or more than two aneurysms and were enrolled in the Affiliated Hospitalof North Sichuan Medical College for aneurysmal subarachnoid hemorrhages,and from part one in this paper, a total of44ruptured intracranial aneurysmsand55UIAs were found out. The maximum diameter, height, width of neckand parent artery diameter of intracranial aneurysms was measured, and ARand SR were calculated. The maximum diameter, AR, SR, and distributionwere precisely compared between ruptured intracranial aneurysms and UIAs.The continuous data were expressed as means±SDs. The data werecompared between the2groups with t tests and χ2tests as appropriate. Toidentify the independent parameters that had significant correlations with therupture, multivariate logistic regression analyses were separately performedfor all of the aneurysms and for the small (<5mm) aneurysms about diameter,daughter blebs, location, AR and SR. All analyses were performed by usingstatistics software (SPSS20.0, SPSS, Chicago, Ill), and a P value of less than0.05was considered to indicate a significant difference. Receiver operatingcharacteristics (ROC) analysis was used to determine optimal thresholdvalues for rupture status discrimination. Results: For all aneurysms, the maximum diameter, AR and SR weresignificantly larger in ruptured intracranial aneurysms (6.98±2.90mm,2.19±0.78and5.60±3.63, respectively) than in the UIAs (3.32±1.47mm,1.31±0.45,1.61±1.33, respectively; P<0.001). Univariate binary logisticanalysis showed that location, the maximum diameter, AR, SR and daughterblebs were correlated with aneurysm rupture. Multivariate binary logisticanalysis showed that SR and daughter blebs were correlated with aneurysmrupture (P=0.011,0.049, respectively; odds ratio,1.774and4.342,respectively). Especially, in small aneurysms, multivariate logistic regressionrevealed that only SR was associated with ruptured aneurysms (P=0.02; oddsratio,3.23). A receiver operating characteristic analysis was performed forsize ratio in small aneurysms, and the threshold separating ruptured andunruptured groups was2.50and the area under the curve was0.894.Conclusions: This study revealed that aneurysmal site, the maximumdiameter, AR, SR and daughter blebs were risk factors of rupture forintracranial aneurysms. The Possibility of rupture significantly increaseswhen the UIAs size is≥5mm. SR can highly predict the risk of rupture inUIAs, Especially, predicting the risk of rupture in small UIAs(<5mm).

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