Correlation between asymmetric geometry of middle cerebral arterial bifurcations and aneurysm formation
10.3760/cma.j.cn115354-20210121-00049
- VernacularTitle:不对称的大脑中动脉分叉结构与动脉瘤形成的相关性分析
- Author:
Lei YANG
1
;
Siqin HAN
;
Weili HAO
;
Xiangling WANG
;
Xuejing ZHANG
Author Information
1. 石家庄市人民医院神经外科 050011
- Keywords:
Cerebral aneurysm;
Middle cerebral artery bifurcation;
Asymmetric structure;
Morphological parameter
- From:
Chinese Journal of Neuromedicine
2021;20(6):578-583
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the asymmetric geometry of middle cerebral artery (MCA) bifurcations and aneurysm formation.Methods:From January 2017 to April 2020, 65 patients with MCA aneurysm underwent 3D-digital subtraction angiography (DSA) in our hospital were recruited in this study; 170 patients without arterial stenosis or cerebral aneurysm at the same time period were selected as normal control group; their corresponding morphological parameters of MCA bifurcations in the imaging data were analyzed. Bifurcation angle was termed as φ1, while small and large lateral angles were termed as φ2 and φ3, respectively. D2, S2, C2, T2 and E2 represented diameter, sectional area, circumference, tortuosity and ellipticity of the branch forming angle φ2 with parent vessel, respectively; whereas D3, S3, C3, T3 and E3 represented diameter, sectional area, circumference, tortuosity and ellipticity of the branch forming angle φ2 with parent vessel on the contralateral branch, respectively. The independent factors affecting the formation of MCA aneurysm were screened by binary Logistic regression, and the predictive value of independent factors affecting the formation of MCA aneurysm was evaluated by receiver operating characteristic (ROC) curve.Results:(1) The aneurysmal group had significantly larger φ1, significantly smaller φ2 and φ3 than the normal control group ( P<0.05); D3, S3, C3, T2, T3 and E2 in the aneurysmal group were significantly higher/larger than those in the normal control group ( P<0.05). In terms of the symmetry of bilateral branches of blood vessels, the difference of φ3/φ2 ratio between the normal control group and aneurysm group was statistically significant ( P<0.05). (2) Binary Logistic regression results showed that φ2 was the protective factor for aneurysm formation ( OR=0.880, 9 5%CI: 0.844-0.918, P=0.000), while D3 and φ3/φ2 ratio were the risk factors for aneurysm formation ( OR=4.493, 9 5%CI: 1.414-14.278, P=0.011; OR=30.676, 95%CI: 9.884-95.202, P=0.000). (3) The ROC curve showed that the area under the curve of φ2 was the largest, reaching 0.93, and the optimal cut-off point was 104.59°, enjoying sensitivity and specificity of 87.7% and 85.9%, respectively. Conclusion:Normal MCA bifurcations almost show symmetrical morphology, whereas aneurysmal MCA bifurcations show asymmetrical morphology in both lateral angles and daughter branches; φ2 is the best morphological parameter to predict the aneurysm formation of MCA bifurcations.
