目的：采用多层螺旋CT血管造影（CTA）分析胚胎型大脑后动脉（FTP）伴发颅内动脉瘤情况，探讨FTP是否为颅内动脉瘤危险因素。同时对比分析FTP伴发颅内动脉瘤与FTP未伴发颅内动脉瘤的相关临床资料。方法：3名医师复习155例头颅CTA的横断面、多平面重组（MPR）、容积再现（VR）图像，观察FTP是否存在及其分型，同时分析FTP患者与非FTP患者伴发颅内动脉瘤的部位、大小，是否存在蛛网膜下腔出血。电话回访FTP患者是否存在吸烟、高血压、冠心病和糖尿病病史。总结FTP发生率，采用χ2检验分析是否存在性别差异。分别总结FTP与非FTP患者伴发颅内动脉瘤的发生率。采用Fisher确切概率法比较FTP与非FTP患者伴发颅内动脉瘤的发生率，以及伴发颅内动脉瘤的FTP与未伴发颅内动脉瘤的FTP患者在年龄、性别、吸烟史、高血压、冠心病和糖尿病方面是否存在统计学差异。采用二项Logistic回归分析FTP是否为颅内动脉瘤危险因素。结果：FTP总体发生率为16.13%（25/155），男性为12.12%（12/99），女性为23.21%（13/56），其发生率无性别差异（P=0.071）。FTP患者伴发颅内动脉瘤的发生率为20%（5/25），全部为女性，非FTP患者伴发颅内动脉瘤的发生率为6.15%（8/135），FTP与非FTP在伴发颅内动脉瘤的发生率上存在统计学差异（P=0.038）。FTP是颅内动脉瘤发生的危险因素（P=0.031）。伴发颅内动脉瘤FTP患者与未伴发颅内动脉瘤FTP患者在性别、高血压、冠心病及糖尿病方面存在统计学差异（P<0.05），在年龄和吸烟史上不存在统计学差异（P>0.05）。结论：女性FTP患者在同时存在高血压、冠心病或糖尿病病史时，其伴发颅内动脉瘤的发生率明显增高。
Abstract
Objective: To observe fetal origin of posterior cerebral artery(FTP) accompanied with intracranial aneurysm by CT angiography(CTA). To investigate whether FTP is the risk factor of intracranial aneurysm. To analyze clinical datas(including age, gender, smoking history, hypertension, coronary heart disease and diabetes) of FTP patients whether accompanied with intracranial aneurysm. Methods: Three doctors reviewed intracranial CTA of 155 consecutive patients. Whether the FTP existed or not was observed firstly. Then, FTP type and intracranial aneurysms accompanied with FTP were observed carefully, including aneurysms’ location, size, and subarachnoid hemorrhage. The clinical data including smoking history, hypertension, coronary heart disease and diabetes of patients with FTP were interviewed by telephone. The incidence of FTP, intracranial aneurysms accompanied with FTP and non-FTP were calculated respectively. Gender difference about FTP was analyzed by χ2 test. The incidence of intracranial aneurysms(including accompanied with FTP and non-FTP) and their clinical data were analyzed by Fisher’s exact test. Binary logistic regression analysis was used to evaluate weather FTP is the risk factor of intracranial aneurysm. Results: The FTP incidence was 16.13%(25/155) in overall, 12.12%(12/99) in male, 23.21%(13/56) in female. There was no gender difference in FTP incidence(P=0.071). The incidence of intracranial aneurysms accompanied with FTP and non-FTP was 20%(5/25), 6.15%(8/135), respectively. There was statistical difference in the incidence of intracranial aneurysms between FTP and non-FTP(P=0.038). FTP is the risk factor of intracranial aneurysm(P=0.031). There were statistical differences between intracranial aneurysms accompanied with FTP and non-FTP on gender, hypertension, coronary heart disease and diabetes(P<0.05). On the contrary, there were no statistical difference between above on age and smoking(P>0.05). Conclusions: The incidence of intracranial aneurysms about female patients with FTP is significantly higher when they suffered hypertension, coronary heart disease or diabetes.
关键词
颅内动脉瘤 /
大脑后动脉 /
体层摄影术 /
螺旋计算机 /
血管造影术
Key words
Intracranial aneurysm /
Posterior cerebral artery /
Tomography, spiral computed /
Angiography
中图分类号：
Ｒ739.41
Ｒ814.42
Ｒ814.43
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参考文献
[1]Fawcett E, Blachford JV. The Circle of Willis: an Examination of 700 Specimens[J]. J Anat Physiol, 1905, 40(Pt 1): 63-70.
[2]Zada G, Breault J, Liu CY, et al. Internal carotid artery aneurysms occurring at the origin of fetal variant posterior cerebral arteries: surgical and endovascular experience[J]. Neurosurgery, 2008, 63(1 Suppl 1): ONS55-61.
[3]Dimmick SJ, Faulder KC. Normal variants of the cerebral circulation at multidetector CT angiography[J]. Radiographics, 2009, 29(4): 1027-1043.
[4]Okahara M, Kiyosue H, Mori H, et al. Anatomic variations of the cerebral arteries and their embryology: a pictorial review[J]. Eur Radiol, 2002, 12(10): 2548-2561.
[5]Krabbe-Hartkamp MJ, van der Grond J, de Leeuw FE, et al. Circle of Willis: morphologic variation on three-dimensional time-of-flight MR angiograms[J]. Radiology, 1998, 207(1): 103-111.
[6]Kovac JD, Stankovic A, Stankovic D, et al. Intracranial arterial variations: a comprehensive evaluation using CT angiography[J]. Med Sci Monit, 2014, 20: 420-427.
[7]van Raamt AF, Mali WP, van Laar PJ, et al. The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation[J]. Cerebrovasc Dis, 2006, 22(4): 217-224.
[8]Padget DH. The development of the cranial arteries in the human embryo[J]. Contrib Embryol, 1948, 32: 205-261.
[9]van der Lugt A, Buter TC, Govaere F, et al. Accuracy of CT angiography in the assessment of a fetal origin of the posterior cerebral artery[J]. Eur Radiol, 2004, 14(9): 1627-1633.
[10]Wentland AL, Rowley HA, Vigen KK, et al. Fetal origin of the posterior cerebral artery produces left-right asymmetry on perfusion imaging[J]. Am J Neuroradiol, 2010, 31(3): 448-453.
[11]Horikoshi T, Akiyama I, Yamagata Z, et al. Magnetic resonance angiographic evidence of sex-linked variations in the circle of Willis and occurrence of cerebral aneurysms[J]. J Neurosurg, 2002, 96(4): 697-703.
[12]Hillen B, Hoogstraten HW, Van Overbeeke JJ, et al. Functional anatomy of the circulus arteriosus cerebri(Willis Ⅱ)[J]. Bull Assoc Anat(Nancy), 1991, 75(229): 123-126.
[13]叶莹莹，张伟国，陈蓉，等. 64层螺旋CTA显示胚胎型大脑后动脉伴发Willis环多血管段变异的价值[J].中国医学影像技术，2007，23（12）：1773-1776.
[14]Osborn AG. Diagnostic cerebral angiography[M]. 2nd ed. Philadeiphia: Lippincott Williams & Wilkins, 1999: 111.
[15]王洪生，徐新文，王辉，等. CT血管成像评价颅内Willis环变异与前后交通动脉动脉瘤发生的关系[J]. 中国脑血管病杂志，2011，8（12）：641-644.
[16]石建成，刘怀军，赵林，等. 脑血管形态学类型与脑动脉瘤形成相关性研究[J]. 实用放射学杂志，2010，26（10）：1401-1404.
[17]陈仁智，闫宏亮，薄晓霞，等. 双侧胚胎型大脑后动脉38例临床分析[J]. 中国医师进修杂志，2012，35（13）：43-45.
[18]Brinjikji W, Zhu YQ, Lanzino G, et al. Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis[J]. AJNR, 2016, 37(4): 615-620.
[19]Kang HG, Kim BJ, Lee J, et al. Risk Factors Associated With the Presence of Unruptured Intracranial Aneurysms[J]. Stroke, 2015, 46(11): 3093-3098.
[20]Jang EW, Kim YB, Chung J, et al. Clinical Risk Factors Affecting Procedure-Related Major Neurological Complications in Unruptured Intracranial Aneurysms[J]. Yonsei Med J, 2015, 56(4): 987-992.
