应用动态增强磁共振技术预测颅内夹层动脉瘤的壁间血肿在血管内治疗术后转归的研究

Intracranial dissecting aneurysm (IDA) is a kind of intractable cerebrovascular disease. Intramural hematoma, which is one of the typical imaging findings of IDA, can grow continuously in untreated IDA. Endovascular treatment has become the main treatment for this disease. However, the outcome of intramural hematoma after endovascular treatment varies among different individuals: some stop growing after endovascular treatment, while others continue to grow even after the parent artery embolization. At present, the mechanism of the continuous growth of intramural hematoma after endovascular treatment of IDA is unclear. Some authors believe that the continuous hemorrhage of the vasa vasorum in the intramural hematoma results in the continuous enlargement of the intramural hematoma. However, this theory has not been proved by imaging in vivo. So, this study aims to establish a prospective cohort of patients who had an IDA and received an endovascular treatment. All the patients underwent dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) six months before and after the endovascular treatment. According to the follow-up results of MRI, the IDAs were divided into two groups: the hematoma stabilization group and the hematoma enlargement group. Then quantitative analysis for vasa vasorum in intramural hematoma was made and differences between the two groups were compared to determine the association between DCE-MRI related parameters and the outcome of intramural hematoma changes. The feasibility of early prediction of intramural hematoma of IDA by DCE-MRI was investigated to provide theoretical basis for the prognosis and intervention of the disease.

颅内夹层动脉瘤（IDA）是一种难治性脑血管疾病，壁间血肿是其典型影像学征象之一，未治疗的IDA壁间血肿常不断增大。血管内治疗已成为该病的主要治疗方式，但血管内治疗术后壁间血肿的转归在不同个体之间存在差异：有的壁间血肿治疗后停止增长，而有的即使行载瘤动脉闭塞术仍继续增长。目前IDA术后壁间血肿持续生长的具体机制尚不明确，有学者认为壁间血肿内新生血管不断出血造成了壁间血肿的持续增大，但这一理论在活体尚没有早期的影像学评估方法。本项目拟建立血管内治疗的IDA患者的前瞻性队列，对患者在术前及术后半年行动态增强磁共振（DCE-MRI）检查，根据MRI的随访结果分为壁间血肿稳定组和增大组，对壁间血肿内的新生血管进行定量分析，评估组间差异，确定DCE-MRI的相关参数与壁间血肿变化转归之间的关联，探讨DCE-MRI早期预测IDA的壁间血肿转归的可行性，为疾病的转归预后和早期干预方法提供理论依据。

颅内夹层动脉瘤(IDA)是一种具有挑战性的疾病，可导致中青年中风。壁间血肿(IMH)是颅内夹层动脉瘤典型的影像学表现之一，在未治疗的颅内夹层动脉瘤中可持续生长。壁间血肿通常位于中膜层内，由动脉压力下的血液从内膜撕裂进入动脉壁而形成由于手术并发症发生率相对较高，血管内治疗已成为此类病变的一线治疗方法根据载瘤动脉是否得到维持，血管内治疗可分为近端动脉闭塞和重建技术。然而，颅内夹层动脉瘤的复发是血管内治疗的一大挑战，并影响患者的预后。本课题组建立颅内夹层动脉瘤的前瞻性队列，并入组90例患者，术前及术后6个月分别行动态增强MRI检查，收集影像学及临床资料，建立前瞻性队列的数据库。我们的研究证明了LVIS支架治疗椎动脉和基底动脉动脉瘤的可行性和安全性，中期完全闭塞率、发病率和死亡率都是可接受的。双侧夹层动脉瘤治疗效果良好。分阶段血管内栓塞治疗的应用可以降低血栓栓塞事件的风险，以及对侧夹层动脉瘤生长和破裂的风险。血流导向装置可能使完全闭塞栓塞率更高，同时也应考虑载瘤动脉的闭塞。