4D-CTA对颅内动脉瘤诊断的应用价值  

Application of 4D-CT angiography in Diagnosing Cerebral Aneurysms

作　　者：陈谦[1] 程晓青[1] 周长圣[1] 倪玲[1] 罗松[1] 黄伟[1] 

机构地区：[1]南京大学附属金陵医院医学影像科,210002

出　　处：《临床放射学杂志》2015年第3期459-463,共5页Journal of Clinical Radiology

摘　　要：目的与常规三维血管造影(3D-CTA)对比,探讨四维血管造影(4D-CTA)对颅内动脉瘤诊断的价值。方法将80例怀疑颅内动脉瘤或因眩晕入院患者随机分为2组(每组40例),A组采用4D-CTA扫描模式检查,对比剂30 ml;B组采用常规3D-CTA扫描模式检查,对比剂60 ml。测量颈内动脉及大脑中动脉CT值、噪声、信噪比(SNR)、对比噪声比(CNR)进行客观图像质量评价。使用5分法进行主观图像质量评价。对比A组与B组间辐射剂量。对进行DSA检查的患者,以DSA为金标准计算4D-CTA对颅内动脉瘤诊断的准确性。结果 A组颈内动脉及大脑中动脉的CT值高于B组(P<0.01)。A组与B组的颈内动脉及大脑中动脉SNR无显著差异(分别为P=0.68、P=0.25)。A组与B组的颈内动脉及大脑中动脉CNR无显著差异(分别为P=0.89、P=0.59)。A组与B组间主观图像质量评价无显著差异(P>0.05)。A组辐射剂量较B组降低30%。4D-CTA对颅内动脉瘤诊断的特异性、敏感性、阳性预测值、阴性预测值及准确率分别为94.12%、90.00%、94.12%、90.00%、92.59%。结论 4DCTA由低辐射剂量、低对比剂浓度扫描实现的动态脑血管成像图像质量不低于常规3D-CTA。4D-CTA对颅内动脉瘤的诊断有较高的准确性。Objective To evaluate 4D-CT angiography（ 4D-CTA） in diagnosing intracranial aneurysms,and to compared its feasibility,reliability and advantages with those of conventional 3D-CT angiography（ 3D-CTA）.Methods A total of 80 patients with suspected intracranial aneurysms or clinically having the symptoms of vertigo were enrolled in this study.The patients were randomly and equally divided into two groups.4D-CTA of the whole brain using 30 ml iodinated contrast agent was employed in the patients of group A（ n = 40）; while conventional CTA of the whole brain using 60 ml iodinated contrast agent was performed in the patients of group B.CT values of the internal carotid artery（ ICA） and middle cerebral artery（ MCA）,signal-to-noise ratio（ SNR） and contrast-to-noise ratio（ CNR） were measured,based on which the objective evaluation of the image quality was conducted.Using 5 points scale method the subjective image quality was assessed.The radiation dose was determined,and the results were compared between the two groups.For the patients who received DSA examination,the diagnostic accuracy of DSA for intracranial aneurysms was calculated,taking DSA results as the gold standard.Results CT values of both ICA and MCA in group A were higher than those in group B（ P 〈 0.01）.No statistically significant differences in SNR and in CNR of both ICA and MCA existed between group A and group B（ P= 0.68 and P = 0.25; P = 0.89 and P = 0.59 respectively）.The difference in subjective image quality score between the two groups was not significant（ P 〉 0.05）.The radiation dose of group A was lower than that of group B by 30%.The specificity,sensitivity,positive predictive value,negative predictive value and accuracy of 4D CTA for the diagnosis of intracranial aneurysm were 94.12%,90.00%,94.12%,90.00% and 92.59%,respectively.Conclusion The image quality of dynamic cerebral angiography,which is performed by 4D-CTA with low radiation dose and low concentration contrast agent,is as good as that obtained

关 键 词：4D-CTA 3D-CTA 颅内动脉瘤 图像质量 辐射剂量 

分 类 号：R743[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]