64层CTA对急性非外伤性蛛网膜下腔出血的应用价值  

The value in detection of acute nontraumatic subarachnoid hemorrhage with 64-slice multidetector CT angiography

作　　者：杜忆兵[1] 闫宇涛[1] 王晓辉[1] 陆利霞[1] 

机构地区：[1]解放军第153中心医院放射科,河南郑州450042

出　　处：《医学影像学杂志》2009年第4期388-390,共3页Journal of Medical Imaging

摘　　要：目的:用64层螺旋CTA评价急性非外伤性蛛网膜下腔出血(SAH)病因并选择治疗方法。方法:对68例急性非外伤性SAH患者发病7天内行CTA检查,明确病因,根据CTA结果选择治疗方法并评价疗效。图像处理采用MPVR、MIP及3DVR重建。结果:68例SAH患者均经DSA及外科手术证实。其中45例为动脉瘤破裂所致,1例血管炎,2例动脉硬化,1例夹层动脉瘤,19例动脉无明显异常。68例SAH中64例由CTA做出病因诊断(准确率94.1%、敏感性91.8%、特异性100%、阳性预测值100%、阴性预测值82.6%)。CTA直接显示43例动脉瘤,1例血管炎及1例夹层动脉瘤。43例动脉瘤有42例根据CTA结果选择治疗(97.7%)。其中栓塞29例,有26例(89.7%)栓塞满意。13例行外科手术钳闭。结论:64层CTA能准确评价SAH病因及动脉瘤的特征。对选择治疗方法十分有价值。Objective：To evaluate the role of 64-slice muhidetector CT angiography （CTA） in detecting the cause and determining the treatment of patients with acute subaraclmoid hemorrhage （SAH） strategy. Methods：Sixty-eight patients underwent CTA to make the early diagnosis and to find the cause of acute SAIl. Treatment decision was based on CTA and the clinical efficacy was also evaluated. Image processing included multiplanar volume reformatted （MPVR）, maximum intensity projections （MIP） and 3D votume-rendered reconstructions.Results：All the CTA findings were confirmed by DSA or neurosurgieal operation. Among them, 45 had aneurysmal SAH, 1 had vasculitis, 2 had arterial sclerosis, 1 had arterial dissection and 19 had no underlying abnomrality. Correct diagnosis was made with CTA in 64 out of the 68 patients （accuracy 94.1%, sensitivity 91.8%, specificity 100%, positive predictive value 100%, negative predictive value 82.6%）. CTA rerealed the aneurysm in 43 of 45 patients, 1 of 1 vasculitis and 1 of 1 dissection. Of the 43 patients with aneurysm, 42（97.7 % ） were referred for treatment based on CTA. 29 were referred to endovascular treatment and successful eoiling was achieved in 26 （89.7%）, and 13 were refered for surgical clipping. Condusion：64-slice CTA is an accurate tool for detecting the cause and characterizing aneurysms in acute SAH. It is helpful in detenning whether to coil or clip an aneurysm.

关 键 词：蛛网膜下腔出血 动脉瘤 体层摄影术 X线计算机 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]