多期CT血管造影在颅底脑膜瘤术前评估中的应用  

Multi-phase CT Angiography in Preoperative Evaluation of Skull Base Meningioma

作　　者：宋岩 张红娟[1] 张俊祥[2,3] 郭涛 随玉真 赵瑞芳 SONG Yan;ZHANG Hongjuan;ZHANG Junxiang;GUO Tao;SUI Yuzhen;ZHAO Ruifang(Department of Radiology,the First Affiliated Hospital of Bengbu Anhui Medical College,Bengbu 233004,Chin;Department of Radiology,Shanghai Deji Hospital,Shanghai 200331,China)

机构地区：[1]界首市人民医院影像中心,安徽界首236500 [2]蚌埠医学院第一附属医院放射科,安徽蚌埠233004 [3]上海德济医院放射科,上海200331

出　　处：《中国医学影像学杂志》2017年第10期738-741,共4页Chinese Journal of Medical Imaging

摘　　要：目的颅底脑膜瘤手术难度大,血管相关并发症凶险。本文探讨多期CT血管造影在颅底脑膜瘤术前评估中的价值,为提高手术安全性提供参考。资料与方法收集2015年1月-2016年12月蚌埠医学院第一附属医院经手术病理证实的颅底脑膜瘤患者46例。所有患者术前均接受多期CT血管造影检查。应用多平面重组、容积再现、多期图像融合等后处理技术,观察肿瘤供血动脉、瘤体与邻近血管的关系,并与术中所见结果比较,评价术前血管造影结果与术中所见结果的一致性。结果 CT血管造影显示,44例可清晰显示肿瘤供血动脉,其中单纯颈外动脉供血15例、颈内外动脉混合供血13例、单纯颈内供血16例,2例显示不清。与术中所见对比,吻合率达84.78%,两者检查结果一致性较好(Kappa=0.78)。46例患者中,血管未受侵36例,血管受侵10例,多期CT血管造影与术中所见对比,吻合率达95.65%,两者检查结果一致性较好(Kappa=0.93);动脉期CT血管造影与术中所见对比,吻合率为67.39%,两者检查结果一致性一般(Kappa=0.45)。结论多期CT血管造影能够清晰地显示颅底脑膜瘤的供血动脉及其与邻近血管的关系,对术前准确评估手术风险、制订手术方案、提高手术安全性具有重要意义。Purpose The operating skull base meningioma is difficult, and the blood vessel related complications are extremely dangerous. This paper aims to investigate the value of multi-phase CT angiography in preoperative evaluation of skull base meningioma, hoping to improve the operation safety. Materials and Methods The data of a total of 46 patients with pathologically confirmed skull base meningioma in the First Affiliated Hospital of Bengbu Medical College from January 2015 to December 2016 were retrospectively analyzed. Preoperative multi-phase CT angiography was performed on all patients. Post-processing techniques were used to observe the relationship between the supply artery of the tumor, the tumor body and the adjacent vessels, including multi-plane reformation, volume rendering and multi-phase image fusion, the observed results were compared with the intraoperative findings, and the consistency between preoperative angiographic results and intraoperative findings was evaluated. Results Among the CT angiography data of these 46 patients, 44 cases could clearly display the supply artery of the tumor, including 15 cases of simple external carotid artery, 13 cases of mixed internal and external carotid artery, 16 cases of simple internal carotid artery and 2 unclear cases. Compared with the intraoperative findings, the coincident rate was 84.78%, with a favorable consistency（Kappa=0.78）. Among the 46 patients, 36 cases had no invasion in blood vessels and 10 cases had vascular invasion. The coincident rate between the results of multi-phase CT angiography and intraoperative findings reached 95.65%, and the consistency was favorable（Kappa=0.93）; the coincident rate between the results of arterial phase CT angiography and intraoperative findings was 67.39%, and the consistency was ordinary（Kappa=0.45）. Conclusion Multi-phase CT angiography can clearly display the feeding artery of skull base meningioma and its relationship with adjacent vessels, and it is of great significance for the preoperative evalu

关 键 词：脑膜瘤 体层摄影术 螺旋计算机 脑血管造影术 图像处理 计算机辅助 神经外科手术 

分 类 号：R445.3[医药卫生—影像医学与核医学] R739.45[医药卫生—诊断学]