以搏动性耳鸣为首发症状的硬脑膜动静脉瘘的CTA评估  

Role of computed tomographic angiography in the evaluations of dural arteriovenous fistulas with pulsatile tinnitus as initial symptom

作　　者：赵鹏飞[1] 帕米尔·阿布都卡地[1] 鲜军舫[1] 梁熙虹[1] 燕飞[1] 杜望[1] 吕晗[1] 王振常[2] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,100730 [2]首都医科大学附属北京友谊医院放射科

出　　处：《中华医学杂志》2013年第33期2622-2626,共5页National Medical Journal of China

基　　金：国家自然科学基金（81171311,81371545）;北京市教委科技发展重点项目（KZ20110025029）;北京市科委首都临床特色项目（D101100050010031）

摘　　要：目的评估颞骨CT血管造影（CTA）对搏动性耳鸣（PT）患者中硬脑膜动静脉瘘（DAVFs）检出的敏感性和特异性。方法分析2008-2012年首都医科大学附属北京同仁医院因PT入院，同时行颞骨CTA及数字血管造影（DSA）检查的患者资料。纳入经DSA诊断DAVFs的患者9例；同时纳入性别、年龄匹配但DSA未显示DAVFs的患者9例。由2位放射科医师在不知结果的情况下，评估以下征象的发生情况：颈外动脉分支不对称增粗、颈内静脉早显、颅底静脉丛不对称增多、静脉窦表面毛糙散乱、海绵窦提前显影、静脉窦狭窄、脑内皮质静脉不对称增粗、颞枕骨骨穿支不对称增多、棘孔不对称扩大。结果颈外动脉分支增粗的敏感性78％、特异性100％；颈内静脉早显的敏感性89％、特异性100％；颅底静脉丛不对称增多的敏感性89％、特异性89％；静脉窦表面毛糙散乱及颞枕骨骨穿支增多的敏感性均67％、特异性均为100％；海绵窦不对称显影的敏感性22％、特异性100％；静脉窦狭窄的敏感性33％、特异性78％；棘孔扩大的敏感性56％、特异性89％。脑内皮质静脉增粗均未见显示。结论CTA可用于对PT患者中DAVFs的筛查性诊断，其中颅底静脉丛增多、颈内静脉早显、颈外动脉分支增粗、静脉窦表面毛糙散乱、颞枕骨骨穿支增多具有较高的敏感性和特异性。颈外动脉分支增粗提示该分支为DAVFs的供血动脉。此外，颞枕骨骨穿支增多和棘孔增宽可应用于平扫CT上对该病的评估。Objective To evaluate the sensitivity and specificity of computed tomographic angiography （CTA） for dural arteriovenous fistulas （DAVFs） in patients presenting with pulsatile tinnitus （PT）. Methods The clinical and imaging data were collected for all patients undergoing CTA for PT from 2008 to 2012. Nine PT patients with DAVFs confirmed by digital subtraction angiography （DSA） and 9 age- and gender-matched control PT patients without DAVFs were selected. The CTA images were blindly analyzed by two experienced neuroradiologists for the following signs： asymmetric venous collaterals in extracranial space, asymmetric attenuation of internal jugular vein （ IJV）, asymmetric external carotid artery （ECA） branches, ＂shaggy＂ appearance of dural venous sinus, muhiple transcalvarial channels, enlarged foramen spinosum, asymmetric cavernous sinus and enlarged cortical veins. Results The sensitivities of the following DAVFs signs were quite different： asymmetric attenuation of IJV （ 89% ） , asymmetric venous collaterals （ 89% ）, asymmetric ECA branches （ 78% ）, shaggy dural venous sinus （ 67% ）, multiple transcalvarial channels （67%）, enlarged foramen spinosum （56%）, stenosis of venous sinus （33 % ） and asymmetric cavernous sinus （ 2 2 % ） . The presence of asymmetric attenuation of IJV , asymmetric ECA branches, shaggy dural venous sinus, multiple transcalvarial channels and asymmetric cavernous sinus all demonstrated a highly specificity of 100% while the presence of asymmetric venous collaterals and enlarged foramen spinosum had a specificity of 89%. The presence of stenosis of venous sinus revealed a specificity of 78%. Enlarged cortical veins were all absent. Conclusion CTA may be used as a screening examination for DAVFs in PT patients. The presence of asymmetric venous collaterals, asymmetric attenuation of IJV, asymmetric ECA branches, shaggy dural venous sinus and multiple transcalvarial channels has a high sensitivity and specificity for diagnosis. Enl

关 键 词：硬脑膜动静脉瘘 搏动性耳鸣 体层摄影术 X线计算机 数字减影 血管造影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]