A CTA-based Study On Risk Factors Of Ruptured Intracranial Aneurysm

Objective: Computed tomography angiography(CTA)was used to explore the risk factors of ruptured intracranial aneurysm,thereby improving the understanding of the risk of ruptured aneurysms,and providing the relevant basis for clinical prevention and treatment of ruptured intracranial aneurysm and bleeding.Methods: All the consecutive cases of patients who received cranial CTA in our hospital from September 2015 to September 2022 were retrospectively screened and analyzed,and the data of single arterial aneurysms with complete clinical and CTA examinations were collected.According to the presence of rupture,the patients were divided into a rupture group and a non-rupture group.70% of the patients were randomly selected as the modeling group,and the rest 30% were selected as the prediction group.Meanwhile,the gender,age,smoking history,alcohol history,hypertension history,diabetes history,heart disease history,thyroid disease history,cerebral ischemic stroke history,intracranial tumor history,aspirin use history,uric acid abnormalities,hyperlipidemia,and family history of intracranial aneurysm of the patients were recorded.The data recorded by CTA included site of aneurysm,incident angle,aneurysm neck width,aneurysm height,aneurysm length,parent artery diameter,aneurysm width diameter,aneurysm morphology regular or not,and the ratio between parameters(aneurysm height/aneurysm neck width,aneurysm length/ parent artery diameter,aneurysm height/aneurysm width diameter,aneurysm width diameter/tumor neck width).Univariate analysis of all the clinical and CTA data was conducted.Logistic multivariate regression analysis of the results based on modeling data set was performed.Nomogram scoring model was constructed.The goodness of fit was obtained by the Hosmer-Lemeshow test,and the ROC curve was employed to evaluate the model’s predictive ability.In this study,P<0.05 represents that the difference is statistically significant.Results: 215 cases of patients with single intracranial aneurysms met the inclusion criteria,with 145 cases in rupture group and 70 cases in non-rupture group.(1)The data of the modeling group and the prediction group only had statistical differences in the incident angle(P<0.05),and the modeling group and the validation group had high consistency.(2)Single-factor analysis results of rupture influencing factors suggested that there were statistical differences in gender,location,morphology,history of hypertension,history of aspirin use,aneurysm neck width,aneurysm height,aneurysm length(maximum diameter),aneurysm height/aneurysm neck width,aneurysm length/parent artery diameter,arterial aneurysm width-diameter,aneurysm height/aneurysmwidth-diameter,aneurysm width-diameter/aneurysm neck width(P<0.05).(3)The single-factor analysis of ruptured aneurysm risk in the anterior and posterior communicating arteries showed statistical differences in incidence angle and morphology(P<0.05).In patients with posterior communicating aneurysms,significant differences were found in age group,alcohol consumption,morphology,and hypertension(P<0.05).In patients with anterior communicating aneurysms,there were statistical differences in stroke and arterial aneurysm width-diameter(P<0.05).(4)After controlling confounding factors,the Logistic regression results showed that in multi-categorical data,anterior communicating artery,posterior communicating artery,middle cerebral artery,female,hypertension,morphology,aneurysm neck width,aneurysm height/aneurysm neck width,aneurysm length,and arterial aneurysm width-diameter were all independent influencing factors(P<0.05);the area under the predictive ability curve of Nomogram scoring model was 0.969.Conclusions: Location(posterior and anterior communicating arteries,middle cerebral artery),female,hypertension,irregular morphology,aneurysm neck width,aneurysm height/aneurysm neck width,aneurysm length,and aneurysm width-diameter were independent risk factors.The nomogram model has a good predictive ability and high accuracy in predicting the rupture risk of unruptured aneurysms based on relevant image features obtained by cranial CTA.It can help clinicians to understand the risk factors of the unruptured aneurysm more comprehensively,to carry out more scientific personalized management,and to formulate more comprehensive and personalized treatment and follow-up schemes...