320排动态容积CTA与3D-DSA对颅内小型动脉瘤诊断价值的对比研究  

Diagnosis of small intracranial aneurysm: 320-slice dynamic volume computerized tomography angiography verse three dimensional digital subtraction angiography

作　　者：刘昊[1] 秦尚振[2] 杨铭[2] 潘力[2] 程少容[3] 

机构地区：[1]南方医科大学武汉临床学院神经外科,武汉430070 [2]广州军区武汉总医院神经外科,武汉430070 [3]广州军区武汉总医院影像科,武汉430070

出　　处：《中国临床神经外科杂志》2013年第6期337-340,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的对比评价320排动态容积CT四维血管造影(4D-CTA)和三维数字减影血管造影(3D-DSA)对颅内小动脉瘤(SAN)的诊断价值。方法 2012年1月至2012年4月,临床怀疑颅内动脉瘤的患者185例均行4D-CTA和3D-DSA检查,应用三维工作站行图像后处理。结果结合3D-DSA所见,185例中的87例患者发现99个小动脉瘤,4D-CTA正确检出94个小动脉瘤,7例显示为假阴性,2例显示为假阳性。在总体检出SAN数量方面,4D-CTA的敏感性为92.9%,特异性为93.9%,准确性为93.2%,4D-CTA与3D-DSA的一致性为优(Kappa值=0.83);对于SAN瘤体最大径的测量,CTA容积重建图像与3D-DSA容积重建图像测量值[(3.0±0.73)mm∶(3.3±0.98)mm]差异无统计学意义(P>0.05)。结论 320排4D-CTA对诊断SAN的敏感性、特异性和准确性很高,可作为颅内动脉瘤筛查和术前评估的首选技术之一,但对于颈内动脉颅内段和椎-基底动脉的小动脉瘤仍有漏诊。Objective To compare the values of 320-slice dynamic volume four-dimensional computerized tomography angiography （4D-CTA） to the diagnosis of small intracranial aneurysm （maximal aneurismal diameter ≤5 mm） with that of three dimensional digital subtraction angiography （3D-DSA）. Methods From January, 2012 to April, 2012 4D-CTA and 3D-DSA examinations were performed in 185 with suspectable iutracranial aneurysms. All the images were obtained from 3D reconstruction workstation. Results Of 99 small intraeranial aneurysms which were detected by 3D-DSA in 87 of the 185 patients, 92 were found out by 4D-CTA, and 7 did not. Moreover, 2 small aneurysms found by 4D-CTA were not aneurysms on 3D-DSA. The sensitivity of 4D-CTA to the small intracranial aneurysms was 92.9%, the specificity was 93.9%, and the accuracy was 93.2%. The agreement of diagnosis of the small intraeranial aneurysms between 4D-CTA and 3D-DSA were excellent （Kappa value--0.83）. There was insignificantly difference between the maximal diameter detected by CTA volume rendering （VR） and that detected by 3D-DSA VR （P〉0.05）. Conclusions Four-dimensional CTA is similar to 3D-DSA in the sensitivity, specificity and accuracy for the detection of small intracranial aneurysm. Although some small aneurysms of intracranial segment of internal carotid artery and vertebrobasilar artery may be omitted by 4D-CTA, 4D-CTA still should be the first choice for screening and preoperative assessment of cranial aneurysm because of no trauma.

关 键 词：颅内小动脉瘤 动态容积CT四维血管造影 三维数字减影血管造影 X线计算机 

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]