64层螺旋CT血管造影在急性自发性出血性脑血管病中的诊断价值  

Value of 64-slice Spiral CT Angiography in Diagnosing Acute Spontaneous Hemorrhagic Cerebral Vascular Diseases

作　　者：王庆国[1] 张贵祥[1] 赵京龙[1] 张洁[1] 张鹤[1] 周志国[1] 

机构地区：[1]卜海交通大学附属第一人民医院放射科,上海201620

出　　处：《中国医学影像学杂志》2012年第10期738-740,744,共4页Chinese Journal of Medical Imaging

摘　　要：目的评价64层螺旋CT血管造影(CTA)在急性自发性颅内出血病因诊断中的价值。资料与方法58例急性颅内出血患者术前采用容积重建(VR)和最大密度投影(MIP)方法进行CTA及数字减影血管造影(DSA)检查,并与手术结果相对照。结果 58例患者中,DSA及手术证实颅内动脉瘤32例(35个),脑动静脉畸形9例,烟雾病6例,静脉畸形伴海绵状血管瘤1例,静脉窦血栓1例,未发现异常9例。对35个动脉瘤,CTA正确诊断34个,漏诊1个。1例阴性病例误诊为动脉瘤;1例海绵状血管瘤伴静脉畸形误诊为动静脉畸形。CTA对9例脑动静脉畸形、1例静脉窦血栓及6例烟雾病均诊断正确。CTA对急性出血性脑血管病的诊断敏感性为96.3%(52/54),特异性为90.0%(9/10),阳性预测值为98.1%(52/53),阴性预测值为81.8%(9/11),准确性为95.3%(61/64)。结论 CTA对急性自发性颅内出血病因诊断的准确性与DSA相近,可作为首选筛查手段。Purpose To assess the value of 64-slice spiral computed tomography angiography（CTA） in the detection of acute spontaneous intracerebral hemorrhage（ICH）.Materials and Methods 58 consecutive patients with spontaneous ICH underwent 3D-CTA.Original CT data were transferred to workstation for reconstruction and were displayed on volume rendered（VR） and maximum intensity projection（MIP） images.The results were compared with pathological results.Results Forty-nine of the 58 patients demonstrated angiographic abnormalities,including aneurysms（n=32）,arteriovenous malformations（n=9）,moyamoya disease（n=6）,cavernous hemangioma with developmental venous anomaly（n=1） and cereberal venous sinus thrombosis（n=1）.CTA detected 34 aneurysms correctly except one case of small aneurysm.One case of cavernous hemangioma with developmental venous anomaly was misdiagnosed as arteriovenous malformations.The overall sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CTA were 96.3%（52/54）,90.0%（9/10）,98.1%（52/53）,81.8%（9/11） and 95.3%（61/64）,respectively.Conclusion 64-slice spiral CTA is nearly as accurate as DSA in determining the cause of acute spontaneous ICH and can be used as the first screening test in patients presenting with spontaneous ICH.

关 键 词：颅内出血 体层摄影术 螺旋计算机 脑血管造影术 血管造影术 数字减影 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.3[医药卫生—临床医学]