Study The Value On Pulsative Points And Monitoring Dynamic Morphological Changes Of Intracranial Aneurysms By ECG-gated 4-Dimensional CT Angiography

Part?Study the value on pulsative points and monitoring dynamic morphological changes in unruptured cerebral aneurysms by ECG-gated 4-dimensional CT angiographyObjective Electrocardiographic(ECG)gated 4-dimensional computed tomographic angiography(4D-CTA)was performed for patients with unruptured cerebral aneurysms(URCAs)to detect pulsation of the cerebral aneurysms and its follow-up.The clinical usefulness of this method was then evaluated.Methods 48 patients had 62 URCAs.Examinations of ECG gated 4D-CTA of Dual-source CT were used for the 62 URCAs.We could receive 20 sets of data that the time intervals were 5%in a cardiac cycle by rebuilding the original data after scanning.Then images and dynamic diagrams could be got by the workstation of 3D software treatment.We concluded the convex was point of impulse if small bubble or small pointed convex could be found in continuous three or more images at the same location.The 62 URCAs were divided into two groups based on whether having a point of impulse.All the URCAs had the follow-ups by 3D-CTA or ECG gated 4D-CTA more than120 days later.The dameter of aneurysms and aspect ratio between the two groups were compared with independent sample t test while neck of aneurysms and follow-up time were compared with two-independent samples Mann-Whitney U test.The other variables including history of hypertension,Type 2 diabetes,smoking et al between the two groups were analyzed by?~2 test.Sensitivity and specificity of aspect ratio for diagnosis of pulsation were analyzed by receiver operating characteristic(ROC)curve.Results Pulsation was observed in 28 of the 62 URCAs.Aspect ratio in whom pulsation was or was not detected was statistically significant(t=-2.274,p<0.001).The aspect ratio of sensitivity and specificity were 75%and 70.6%.After follow-up more than 3 months,of the 28 URCAs in which pulsation was observed,11 showed a change in shape while 34 URCAs in which pulsation was not observed,5 showed a change in shape.The aneurysms in which pulsation was detected were more likely to show a change in shape(?~2=4.891,p=0.027),with an odds ratio of 3.753.Conclusion URCAs with large aspect ratio are easily to detect the pulsation by ECG gated 4D-CTA.Besides,the aneurysms in which pulsation is detected are more likely to show a change in shape after follow-up,suggesting that ECG gated 4D-CTA may be useful to predict aneurysms with a higher risk of rupture.Part ? Study the value on pulsative points of ruptured intracranial aneurysms by ECG-gated 4-dimensional CT angiographyObjective To investigate the clinical value of pulsative points of ruptured intracranial aneurysm by observing the beating in every heart period in the examination of ECG-gated four-dimensional CT angiography(4D-CTA).Methods Examinations of ECG gated 4D-CTA of Dual-source CT are used for the 102 patients of ruptured intracranial aneurysms.We can receive 20 set of data that the time interval are 5% in a cardiac cycle by rebuilding the original data after scanning.Then images and dynamic diagrams can be got by the workstation of 3D software treatment.We conclude the convex is point of impulse if small bubble or small pointed convex can be found in continuous three or more images at the same location.The 102 patients of ruptured intracranial aneurysms are divided into two groups based on whether having a point of impulse.Then the clinical manifestation age,sex,aspect ratio et al were analyzed by indepent sample t test,two-independent samples Mann-Whitney U test and ?~2 test.Intracranial ruptured aneurysm with a pulsatile point and surgical results are compared at last.Results There are 81 pulsative points in 102 ruptured aneurysms.The comparison of two groups based on whether having a point of impulse in sex(?~2 =0.068),age(t =0.589)and part(?~2 =5.063)was statistically indistinguishable(p>0.05).while diameter(Z=-2.914,p=0.004)and aspect ratio(?~2 =6.115,p=0.013)between the two groups have statistical significance.66 cases are clipped in 81 cases with a pulsative point of aneurysms.We find bleeding area is in line with pulse point's position in 62 cases.Conclusion The diameter and the aspect ratio appears to be the independent factor whether the pulsative point of aneurysm can be found in 4D-CTA.Point of impulse of ruptured intracranial aneurysm is associated with the point of rupture,which have great clinical significance to treatment of ruptured aneurysms.Part ? Monitoring dynamic morphological changes with ECG-gated 4-dimensional CT angiography to predict intraoperative rupture of intracranial aneurysmsObjective To evaluate dynamic morphological changes of intracranial aneurysms in order to predict re-rupture during neurosurgical clipping.Methods Included in this study were 153 patients,who had ruptured and microsurgical-clipped aneurysms and were under continuous monitoring in a single center.All patients underwent dual-source computed tomography(CT)examination of electrocardiography(ECG)-gated 4-dimensional CT angiography(4D-CTA).Original scanning data were reconstructed to produce 20 data sets of cardiac cycles with 5% time intervals.In addition,20 groups of images and dynamic graphs were generated using three-dimensional software.The aneurysm neck,transverse and longitudinal diameters,and volume from the 20 groups of images were measured to calculate their respective change rates.In addition,other data and clinical characteristics(diameter,aspect ratio,hypertension et al)were recorded.Data were analyzed by logistic regression to identify factors associated with intraoperative aneurysm rupture(IAR).Results Of the 153 patients,24 patients experienced re-rupture during neurosurgery.Multivariate analysis revealed that the aneurysm neck change rate(p< 0.001,OR = 1.276)and aspect ratio(height/neck ratio,p = 0.025,OR = 2.387)are the predictors for IAR during clipping.Receiver operating characteristic curve analysis showed that the aneurysm neck change rate is highly accurate for diagnosis,when the sensitivity and specificity were 91.7% and 76.7%,respectively,and the change rate was ? 60%.In contrast,the aspect ratio was less accurate in predicting IAR.Conclusion Aneurysm neck change rate and aspect ratio are independent predictors of IAR.