心电监控四维CT血管成像检测颅内未破裂动脉瘤搏动点及其意义  

Detection of pulsation in unruptured cerebral aneurysms by electrocardiographic-gated 4-dimensional computed tomographic angiography and follow-up evaluation

作　　者：顾艳[1] 胡春洪[3] 徐伦[4] 骆孟[1] 刘希光[2] 张洪伟[2] 

机构地区：[1]连云港市第一人民医院影像科,222002 [2]连云港市第一人民医院神经外科,222002 [3]苏州大学附属第一医院影像科 [4]连云港市中医院神经外

出　　处：《中华放射学杂志》2017年第6期401-406,共6页Chinese Journal of Radiology

基　　金：连云港市青年英才豪森基金（QN150306）

摘　　要：目的通过心电监控4D-CTA观察颅内未破裂动脉瘤的搏动和随访复查情况，评价搏动点的临床意义。方法2014年5月至2016年9月共纳入48例患者62个未破裂动脉瘤进行4D-CTA检查，将扫描结束后的原始数据进行重建，得出一个心动周期内时间间隔均为5%的20组数据包，经工作站三维软件处理后，得到20幅图像及动态图。将同一部位连续3幅及以上图像发现小泡状或小尖状凸起，判定该凸起为搏动点。根据有无搏动点出现分为有搏动点组和无搏动点组，每例患者在3个月以后进行3D-CTA或4D-CTA复查。动脉瘤直径、瘤颈比在有搏动点组和无搏动点组之间的比较采用独立样本t检验；瘤颈和随访时间采用Mann-Whitney U检验；高血压史、2型糖尿病史、吸烟史等指标在两组间比较采用χ2检验。同时采用ROC曲线分析瘤颈比对动脉瘤搏动点诊断的敏感度和特异度。 结果62个未破裂动脉瘤中，28个动脉瘤有搏动点，瘤颈比在有、无搏动点组间分别为1.5±0.3和1.1±0.3，两组之间差异有统计学意义（t=－2.274，P〈0.01），并且当瘤颈比〉1.2时，诊断搏动点的敏感度和特异度分别为75.0%和70.6%。经过随访复查，28个有搏动点的动脉瘤中，11个可见动脉瘤形状的改变；34个未见搏动点的动脉瘤中，5个可见瘤体形状的改变，两组之间差异有统计学意义（χ2=4.89，P=0.03），有搏动点的未破裂动脉瘤更容易发现动脉瘤形状的改变，OR值为3.753。结论瘤颈比大的未破裂动脉瘤容易在心电监控4D-CTA中发现搏动点，而有搏动点的动脉瘤更容易在随访中发生形态改变；心电监控4D-CTA对颅内未破裂动脉瘤的破裂预测方面有重要意义。Objective To evaluate the electrocardiographic （ECG）-gated 4-dimensional computed tomographic angiography （4D-CTA） in the determination of pulsation of unruptured cerebral aneurysms （URCAs）.MethodsThis study included 48 patients with 62 URCAs. Examinations of ECG gated 4D-CTA of dual-source CT were performed. Twenty sets of image data with the time intervals of 5% in a cardiac cycle were obtained after postprocessing on the workstation. The convex was defined as the point of pulsation if small bubble or small pointed convex could be found in continuous three or more images at the same location. The 62 URCAs were divided into two groups based on whether having a point of pulsation. All the URCAs were scanned at the follow-up by 3D-CTA or ECG gated 4D-CTA more than 120 days later. The diameters of aneurysms and aspect ratio between the two groups were compared with independent t test, while neck of aneurysms and follow-up time were compared with two-independent samples Mann-Whitney U test. The other variables including history of hypertension, type 2 diabetes, smoking et al between the two groups were analyzed by χ2 test. The sensitivity and specificity of aspect ratio for diagnosis of pulsation were analyzed by receiver operating characteristic （ROC） curve. ResultsPulsation was observed in 28 of the 62 URCAs. Aspect ratios in whose pulsation was or was not detected were 1.5±0.3 and 1.1±0.3, respectively. The difference between the two groups was statistically significant （t=-2.274, P〈0.001） . The sensitivity and specificity of the aspect ratio were 75.0% and 70.6%. After follow-up more than 3 months, of the 28 URCAs in which pulsation was observed, 11 showed a change in shape, while in 34 URCAs without visible pulsation, 5 showed a change in shape. The aneurysms with detectable pulsation were more likely to show a change in shape （χ2=4.891, P=0.027）, with an odds ratio of 3.753. ConclusionsURCAs with a large aspect ratio are easily to show the pulsation by ECG gated 4D-CTA. Besides,

关 键 词：颅内动脉瘤 动脉瘤 破裂 体层摄影术 X线计算机 

分 类 号：R743[医药卫生—神经病学与精神病学]