3D-CTA和3D-DSA在自发性蛛网膜下腔出血早期影像诊断的应用  

Application of 3D-CTA and 3D-DSA in early imaging diagnosis of spontaneous subarachnoid hemorrhage

作　　者：李建[1] 刘惠祥[1] 沈鸟松[1] 邱耀忠 倪海波[1] 张立[1] LI Jian;LIU Huixiang;SHEN Niaosong(Department of Neurosurgery , First People＇s Hospital of Zhangjiagang , Zhangjiagang 215600, CHINA)

机构地区：[1]张家港市第一人民医院神经外科,江苏215600

出　　处：《江苏医药》2018年第6期655-658,共4页Jiangsu Medical Journal

基　　金：苏州市科技发展计划-产业技术创新专项(民生科技-医疗卫生应用基础研究)项目(SYSD2017002)

摘　　要：目的比较三维CT血管造影(3D-CTA)及三维数字减影血管造影(3D-DSA)在自发性蛛网膜下腔出血(SSAH)早期影像诊断的应用价值。方法回顾性分析112例SSAH患者的临床资料。所有患者行3D-CTA和3D-DSA检查,比较两者对SSAH早期影像诊断的效率。结果3D-CTA发现颅内动脉瘤91例(检查出动脉瘤102个)、脑动静脉畸形4例、硬脑膜动静脉瘘2例、烟雾病4例、阴性11例。3D-DSA发现颅内动脉瘤95例(检查出动脉瘤112个)、脑动静脉畸形5例、硬脑膜动静脉瘘3例、烟雾病4例、阴性5例。3D-CTA颅内动脉瘤检出率低于3D-DSA(91.07%vs.100%)(P<0.05)。两者对SSAH患者病因诊断的准确性无统计学差异(P>0.05)。3D-CTA和3D-DSA对破裂的责任动脉瘤检出率相仿(95.79%vs.100%)(P>0.05)。结论3D-CTA和3D-DSA在SSAH患者病因诊断准确性相仿,大部分患者可以基于3D-CTA检查结果制定手术方案。3D-CTA对颅内夹层动脉瘤、直径≤3mm的微小动脉瘤、直径<1cm的脑动静脉畸形、硬脑膜动静脉瘘仍有部分漏诊,对3D-CTA检查结果阴性患者,需进一步行3D-DSA检查。Objective To compare the efficiency of 3 D-CTA and 3 D-DSA in early imaging diagnosis of spontaneous subarachnoid hemorrhage（SSAH）.Methods Clinical data of 112 patients with SSAH who underwent 3 D-CTA inspection and 3 D-DSA inspection were retrospectively analyzed.The efficiency of 3 D-CTA and 3 D-DSA in early imaging diagnosis of SSAH was compared.Results A total of 102 aneurysms in 91 patients with intracranial aneurysms was diagnosed by 3 D-CTA,of whom 4 cases were with cerebral arteriovenous malformation,2 cases were with dural arteriovenous fistula,4 cases were with moyamoya disease,and 11 cases were negative.A total of 112 aneurysms in95 patients with intracranial aneurysms was diagnosed by 3 D-DSA,of whom 5 cases were with cerebral arteriovenous malformation,3 cases were with dural arteriovenous fistula,4 cases were with moyamoya disease,and 5 cases were negative.The detection rate of intracranial aneurysm by 3 D-CTA was lower than that by 3 D-DSA（91.07% vs.100%）（P〈0.05）.There was no statistical difference in the accuracy of etiological diagnosis for SSAH between 3 D-CTA and 3 D-DSA（P〈0.05）.The detection rates of 3 D-CTA and 3 D-DSA in the diagnosis of responsible ruptured aneurysm were similar（95.79% vs.100%）（P〉0.05）.Conclusion There is no statistically difference in the accuracy of etiological diagnosis for SSAH between 3 D-CTA and 3 D-DSA.Most patients can be operated on the basis of the results of 3 D-CTA inspection.Some patients with intracranial interlayer aneurysms,aneurysms less than 3 mm in diameter,cerebral arteriovenous malformation less than 1 cm in diameter,and dural arteriovenous fistula may be missed diagnosis by the 3 D-CTA inspection and3 D-DSA inspection is needed in the patients with negative results of 3 D-CTA inspection.

关 键 词：蛛网膜下腔出血 三维CT血管造影 三维数字减影血管造影 颅内动脉瘤 

分 类 号：R651[医药卫生—外科学]