颅内动脉瘤诊断及治疗的影像学评价对比研究  

Comparative Study of Imaging in Diagnosis and Therapy of Intracranial Aneurysms

作　　者：康志雷[1] 石辛景 张钊[1] 

机构地区：[1]衡水市哈励逊国际和平医院核磁室,河北衡水053000 [2]衡水市妇幼保健院,河北衡水053800

出　　处：《CT理论与应用研究（中英文）》2015年第6期827-834,共8页Computerized Tomography Theory and Applications

基　　金：2014年河北省指令性课题(ZL20140001)

摘　　要：目的:评价CTA在诊断及治疗颅内动脉瘤中的临床应用价值。方法:97例临床疑似颅内动脉瘤患者中首先随机选择CTA及MRA两种无创伤检查中的一种,随后均行DSA检查。以DSA和外科手术确诊为参考,比较CTA,MRA及DSA在诊断颅内动脉瘤中的优势和不足。选择相应治疗后,行CTA+DSA或MRA+DSA复查,评价动脉瘤的残留情况。结果:1 50例行CTA+DSA检查组中,确诊阳性病例46例。CTA检测的特异性、灵敏性及准确性分别为66.67%、100%和98%。阴性及阳性预测率分别为100%和97.92%。DSA检测的特异性、灵敏性及准确性分别为66.67%、95.74%和94%。阴性及阳性预测率分别为50%和97.83%。2 47例行MRA+DSA检查组中,确诊阳性病例45例。MRA检测的特异性、灵敏性及准确性分别为50%、97.67%和93.62%。阴性及阳性预测率分别为66.67%和95.45%。DSA检测的特异性、灵敏性及准确性分别为66.67%、97.73%和95.74%。阴性及阳性预测率分别为66.67%和97.73%。3 48例接受动脉瘤颈夹闭术的患者行CTA+DSA复查,以DSA为标准,CTA评价动脉瘤残留的特异性、灵敏性及准确性分别为97.73%、100%和97.78%。42例接受可解脱弹簧圈治疗的患者行MRA+DSA复查,以DSA为标准,MRA评价动脉瘤残留的特异性、灵敏性及准确性分别为100%、66.67%和97.5%。结论:CTA诊断颅内动脉瘤的特异性、灵敏性及准确性稍优于DSA,MRA对于颅内动脉瘤的诊断方面稍低于DSA;同时CTA及MRA均可清晰显示动脉瘤的三维结构及空间关系;综合比较,我们认为CTA对于动脉瘤的诊断及手术方案的确定能提供更多的信息,并可作为术后较为理想的随访影像学检查方法。Objective： To evaluate the clinical value of CTA（CT Angiography, CTA） in the diagnosis and treatment of intracranial aneurysms. Methods： 97 cases of patients with clinically suspected of intracranial aneurysms were randomly detected by one of the non-invasive examination CTA and MRA first, and then underwent a DSA examination. Comparing with DSA and surgical diagnosis, we discussed the advantages and disadvantages of CTA, MRA and DSA. After acceptance of the appropriate treatment, patients underwent a CTA ＋ DSA examination or a MRA ＋ DSA examination, and evaluate of residual aneurysm case. Results：（1） 50 patients in CTA ＋ DSA inspection group, 46 cases were confirmed as positive cases. The specificity, sensitivity and accuracy of CTA detection were： 66.67%, 100%, and 98%. Negative and positive predictive values were： 100%, 97.92%. The specificity, sensitivity and accuracy of DSA detection were： 66.67%, 95.74%, and 94%. Negative and positive predictive values were： 50%, 97.83%.（2） 47 patients in MRA ＋ DSA inspection group, 45 cases were confirmed as positive cases. The specificity, sensitivity and accuracy of MRA detection were： 50%, 97.67%, and 93.62%. Negative and positive predictive values were： 66.67%, 95.45%. The specificity, sensitivity and accuracy of DSA detection were： 66.67%, 97.73%, and 95.74%. Negative and positive predictive values were： 66.67%, 97.73%.（3） 48 patients who underwent aneurysm clipping surgery detected by CTA ＋ DSA examination, and DSA as the standard, CTA evaluation of residual aneurysm specificity, sensitivity and accuracy were： 97.73%, 100%, and 97.78%. 42 cases accepted relief coil therapy detected by MRA ＋ DSA examination,and DSA as the standard, MRA evaluation of residual aneurysm specificity, sensitivity and accuracy were： 100%, 66.67%, and 97.5%. Conclusion： CTA diagnosis of intracranial aneurysms specificity, sensitivity and accuracy slightly better than DSA, MRA for the diagnosis of intracranial aneurysms is slightly lower

关 键 词：颅内动脉瘤 数字减影血管造影 CT冠脉血管造影 磁共振血管造影 

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] R445.2