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Original Research |

Prevalence of Unruptured Cerebral Aneurysms in Chinese Adults Aged 35 to 75 Years: A Cross-sectional Study

Ming-Hua Li, MD, PhD*; Shi-Wen Chen, MD, PhD*; Yong-Dong Li, MD, PhD; Yuan-Chang Chen, MD; Ying-Sheng Cheng, MD, PhD; Ding-Jun Hu, MD; Hua-Qiao Tan, MD, PhD; Qian Wu, MD; Wu Wang, MD; Zhen-Kui Sun, MD; Xiao-Er Wei, MD; Jia-Yin Zhang, MD, PhD; Rui-Hua Qiao, MS; Wen-Hong Zong, MD; Yin Zhang, MD; Wei Lou, MD; Zhi-Yuan Chen, MD; Yu Zhu, MD; De-Rong Peng, MD; Sui-Xin Ding, MD; Xue-Fan Xu, MD; Xu-Hong Hou, MD, PhD; and Wei-Ping Jia, MD, PhD*
[+] Article and Author Information

* Drs. M.H. Li (e-mail, shliminghua@163.com) and W.P. Jia (e-mail, wpjia@sjtu.edu.cn) were corresponding authors and contributed equally to this study. Dr. S.W. Chen was the first author of this study.


From Institute of Diagnostic and Interventional Radiology, Sixth People's Hospital, Shanghai Jiao Tong University; Linfen Community Health Care Center; and Huayan Community Health Care Center, Shanghai, China.

Acknowledgment: The authors thank Drs. Gen-Ming Zhao and Guo-You Qin (School of Public Health, Shanghai Fu Dan University, Shanghai, China) for their assistance with the statistical analysis of the data during the preparation of this manuscript and Dr. C.S. Zee (Department of Neuroradiology, Keck Hospital of University of Southern California, Los Angeles, California) for editorial assistance.

Grant Support: By National Natural Science Foundation of China (grants 81171440 and 30970793), Twelfth Five-Year National Science and Technology Support Program of China (grants 2011BAI08B14 and 2011BAI08B06), Shanghai Important Subject Fund of Medicine (grants 05III023 and 074119505), and Program for Shanghai Outstanding Medical Academic Leader (grant LJ 06016).

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0927.

Reproducible Research Statement: Study protocol: The protocol is fully described in the manuscript. Statistical code: Available on request. Data set: Medicare data sets are available to qualified researchers but cannot be released by the investigators.

Requests for Reprints: Yong-Dong Li, MD, PhD, Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, China 200233; e-mail, dr_liyongdong@sina.com.cn.

Current Author Addresses: Drs. M.H. Li, S.W. Chen, Y.D. Li, Y.C. Chen, Cheng, Hu, Tan, Wu, Wang, Sun, Wei, J.Y. Zhang, Hou, Jia, and Ms. Qiao: 600 Yi Shan Road, Shanghai, China 200233.

Drs. Zong, Y. Zhang, Lou, and Zhu: 760 Yan Qu Road, Shanghai, China 200435.

Drs. Z.Y. Chen, Peng, Ding, and Xu: 315 An Hua Road, Shanghai, China 200050.

Author Contributions: Conception and design: M.H. Li, S.W. Chen, Y.D. Li, W.P. Jia.

Analysis and interpretation of the data: M.H. Li, Y.D. Li, H.Q. Tan.

Drafting of the article: S.W. Chen, Y.D. Li, J.Y. Zhang.

Critical revision of the article for important intellectual content: M.H. Li, Y.D. Li, J.Y. Zhang, W.P. Jia.

Final approval of the article: M.H. Li, Y.D. Li, W.P. Jia.

Provision of study materials or patients: S.W. Chen, Y.D. Li, Y.S. Cheng, H.Q. Tan, W. Wang, R.H. Qiao, W.H. Zong, Y. Zhang, W. Lou, Z.Y. Chen, Y. Zhu, D.R. Peng, S.X. Ding, X.F. Xu, W.P. Jia.

Statistical expertise: Y.D. Li, X.H. Hou.

Obtaining of funding: M.H. Li, S.W. Chen, Y.D. Li, W.P. Jia.

Administrative, technical, or logistic support: M.H. Li, S.W. Chen, Y.D. Li, Y.S. Cheng, W.P. Jia.

Collection and assembly of data: S.W. Chen, Y.D. Li, Y.C. Chen, D.J. Hu, H.Q. Tan, Q. Wu, W. Wang, Z.K. Sun, X.E. Wei, W.P. Jia.


Ann Intern Med. 2013;159(8): 514-521. doi:10.7326/0003-4819-159-8-201310150-00004
Text Size: A A A

Chinese translation

Background: The reported prevalence of unruptured cerebral aneurysms (UCAs) varies widely.

Objective: To measure the prevalence of UCAs by using 3-dimensional time-of-flight magnetic resonance angiography in adults aged 35 to 75 years.

Design: Cross-sectional study done between June 2007 and June 2011.

Setting: Two communities chosen at random from 2 districts (1 urban and 1 suburban) in Shanghai, China.

Participants: 4813 adults aged 35 to 75 years.

Measurements: Three-dimensional time-of-flight magnetic resonance angiography, interpreted by 3 observers blinded to the participants’ information, was used to identify the location and size of UCAs and to estimate the overall, age-specific, and sex-specific prevalence.

Results: 369 UCAs were found in 336 participants (130 men and 206 women); 4477 participants had no evidence of UCAs. The prevalence was 7.0% overall (95% CI, 6.3% to 7.7%), with 5.5% for men (CI, 4.6% to 6.4%) and 8.4% for women (CI, 7.3% to 9.5%). The overall prevalence of UCAs was higher in women than in men (P < 0.001) and peaked at ages 55 to 64 years in men and women. The UCAs were mostly located in the internal carotid artery (81%), and 90.2% had a maximum diameter less than 5 mm. Mean diameter was larger in women than in men (3.7 mm vs. 3.2 mm; P < 0.009).

Limitation: Participants were from 2 communities selected from 2 districts in Shanghai, and adults older than 75 years were not studied.

Conclusion: The overall prevalence of UCAs was 7.0% in Chinese adults aged 35 to 75 years, and most lesions had a diameter less than 5 mm.

Primary Funding Source: National Natural Science Foundation of China.

Figures

Grahic Jump Location
Figure 1.

Study flow diagram.

3D-TOF MRA = 3-dimensional time-of-flight magnetic resonance angiography.

Grahic Jump Location
Grahic Jump Location
Figure 2.

Aneurysm of the right posterior communicating artery of an internal carotid artery in a woman aged 47 years.

Top. A 3-dimensional time-of-flight magnetic resonance angiography image reveals a small aneurysm (arrow) of the right posterior communicating artery. Bottom. Image at 19-month follow-up. Note the increase in size of the aneurysm (arrow).

Grahic Jump Location
Grahic Jump Location
Figure 3.

Aneurysm of the anterior communicating artery in a man aged 64 years.

Top. A 3-dimensional time-of-flight magnetic resonance angiography image reveals a small aneurysm (arrow) of the anterior communicating artery. Bottom. Image at 20-month follow-up. Note that the aneurysm is the same size and has the same morphologic characteristics (arrow) as before.

Grahic Jump Location

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Comments

Submit a Comment
Unusual Exclusion Criteria in Aneurysm Study
Posted on November 9, 2013
Lorraine Tosiello, MD, FACP
Jersey City Medical Center, Center for Comprehensive Health Practice and VNA Family Health Center at Asbury Park
Conflict of Interest: None Declared
I have never seen the exclusion criteria "going abroad" and "away on business" used in a clinical trial before. As I am exquisitely sensitive to human rights issues in the People's Republic of China, my innate cynicism asks if these criteria are not euphemisms for "politically detained" or the ever ominous "missing". One wonders if the concept of completely voluntary informed consent can even exist in the climate of coercion that exists in China. I do not intend to disparage our physician colleagues in China, but I do ask that the Annals be certain that the enrollment processes used in clinical trials in countries with oppressive regimes are truly voluntary.
Author's Response
Posted on January 6, 2014
Ming Hua Li, MD, PhD, Yong-Dong Li, MD, PhD
The Sixth Affiliated People's Hospital
Conflict of Interest: None Declared
My colleagues and I have read the letter by Dr. Tosiello and would like to give responses to her comment. We truly understand her concern about the exclusion criteria, specifically what we called "going abroad" and "away on business". The terminology we used here, potentially causing confusion or misunderstanding by readers, refers to the population who is not eligible at the time we conducted this screening survey. Local residents, who were going abroad or on a long business trip, were excluded due to the ineligibility. As we pointing out here, "going abroad" and "away on business" are indeed two detailed reasons for the ineligibility and have nothing to do with so-called "politically detained". In addition, as been mentioned in the article, we did have few people declining to participate in this study. However, all the participants enrolled here were indeed voluntary. Finally, we hope our explanation could help to enhance the understanding of the enrollment processes to our readers.

Ming Hua Li and Yong-Dong Li

Editorial Reluctance to Address the Issue
Posted on April 2, 2014
Lorraine Tosiello, MD, FACP
Jersey City Medical Center
Conflict of Interest: None Declared
Thank you for publishing my letter regarding the possible inability of Chinese citizens to decline participation in clinical trials. However, by having the authors of the paper respond to my letter, the Editors of the Annals have missed the opportunity to explain to their readers how they ensure that coercive methods are not used to recruit participants to clinical trials in countries with authoritarian regimes. I would really like a response from the Editors, not from the authors, who would also be bound by the restrictions placed on them by their political oppressors.
In Response
Posted on April 2, 2014
The Editors
Annals of Internal Medicine
Conflict of Interest: None Declared
The Annals of Internal Medicine follows the ICMJE recommendations (www.icmje.org ). We require authors to attest that their studies received institutional review board and that they obtained patient informed consent in accordance with the principles of the Declaration of Helsinki. Dong and colleagues' article clearly stated that approval of the institutional review board and patient informed consent were obtained. If Dr. Tosiello has specific allegations of unethical treatment of patients enrolled in this study, she should share them with us.



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Summary for Patients

How Common Are Unruptured Brain Aneurysms in Adults?

The full report is titled “Prevalence of Unruptured Cerebral Aneurysms in Chinese Adults Aged 35 to 75 Years. A Cross-sectional Study.” It is in the 15 October 2013 issue of Annals of Internal Medicine (volume 159, pages 514-521). The authors are M.H. Li, S.W. Chen, Y.D. Li, Y.C. Chen, Y.S. Cheng, D.J. Hu, H.Q. Tan, Q. Wu, W. Wang, Z.K. Sun, X.E. Wei, J.Y. Zhang, R.H. Qiao, W.H. Zong, Y. Zhang, W. Lou, Z.Y. Chen, Y. Zhu, D.R. Peng, S.X. Ding, X.F. Xu, X.H. Hou, and W.P. Jia.

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