64排螺旋CT血管造影VR成像与DSA在颅内动脉瘤诊断中的对比研究  

A comparison of volume rendering and digital subtraction angiography in the diagnosis of intracranial aneurysms

作　　者：韩磊[1] 王志刚[1] 丁璇[1] 冀勇[1] 李卫国[1] 张纪庆[1] 邵广瑞[2] 仲海[2] 赵坤[2] 

机构地区：[1]山东大学第二医院神经外科,济南250033 [2]山东大学第二医院影像科,济南250033

出　　处：《山东大学学报（医学版）》2008年第3期296-300,共5页Journal of Shandong University:Health Sciences

摘　　要：目的探讨64排螺旋CT血管造影(computed tomography angiography,CTA)容积再现技术(volume rendering,VR)及数字减影血管造影(digital subtraction angiography,DSA)对颅内动脉瘤的不同诊断价值。方法对38例怀疑颅内动脉瘤的患者行CTA及DSA检查,CTA检查采用VR技术进行后处理,同时辅助最大密度投影技术(maximum inten-sity project,MIP),DSA常规行双侧颈动脉及椎动脉造影。观察对比两者对瘤体和瘤颈的大小、比率,分叶、分支毗邻的显示情况。结果经CTA VR发现颅内动脉瘤35例共41个,经DSA检查证实颅内动脉瘤35例共42个。VR对颅内动脉瘤的敏感度为95.2%,特异度为100%,准确度为89.1%。容积重建成像能清晰显示颅内动脉瘤、形态、分支及与临近结构的关系,对于动脉瘤瘤体/瘤颈比也有准确的显示。结论CTA VR成像可获得与DSA相近的检查结果,对了解颅内动脉瘤的三维结构和制定治疗方案有重要的辅助作用。将DSA与CTA技术结合将有利于更全面、准确地诊断和观察颅内动脉瘤。Objective To explore the role of 64-channel multi-detector row CT angiography（MDCTA） volume rendering （VR） and digital subtraction angiography （DSA） in the diagnosis and characterization of intracranial aneurysms. Methods In this blind prospective study, 38 patients with suspected intracranial aneurysm underwent both 64-channel MDCTA and DSA. VR was adopted to reconstruct images in all cases and some were assisted by the maximum intensity project （MIP） if necessary. The MDCT angiograms were interpreted for the presence, location, size, ratio of the neck to the dome （ N/D ratio）, and lobularity of the aneurysms and relationship of the aneurysm with the adjacent arterial branches. Results A total of 42 aneurysms were detected by DSA in 35 patients and 41 were by CTA, whereas no aneurysms were detected in 3 patients. Compared with DSA, the overall sensitivity, specificity and accuracy of MDCTA on a per-aneurysm basis were 95.2%, 100% and 89.1%, respectively. Of all 42 aneurysms, 3D-CTA with VR well demonstrated aneurysms and provided useful information including the site, shape, size and spatial relationship to the surrounding vessels and bony structures. In addition, MDCTA was also accurate in determining the N/D ratio of aneurysms, aneurysm lobularity and adjacent arterial branches. Conclusion MDCTA is accurate in the detection and characterization of intracranial aneurysms and can be used as a reliable alternative imaging technique to DSA in selected cases. DSA combined with CTA VR is quite useful for the diagnosis and treatment of intracranial aneurysms.

关 键 词：颅内动脉瘤 体层摄影术 X线计算机 图像处理 计算机辅助 脑血管造影术 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]