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检出率评价  

Evaluated the Detection Rate of 3D-CTA and 3D-DSA in Early Imaging Diagnosis of Spontaneous Subarachnoid Hemorrhage

作　　者：邓凯军[1] 张磊[2] 陈镜聪[2] 邓明[1] Kaijun DENG;Lei ZHANG;Jingcong CHEN;Ming DENG(Department of Interventional Medicine,The Central People's Hospital of Huizhou City,Huizhou 516001,China;Department of Radiology,The Central People's Hospital of Huizhou City,Huizhou 516001,China)

机构地区：[1]惠州市中心人民医院介入科,广东惠州516001 [2]惠州市中心人民医院放射科,广东惠州516001

出　　处：《心电图杂志（电子版）》2017年第4期22-23,共2页Journal of Electrocardiogram（Electronic Edition）

摘　　要：目的通过对自发性蛛网膜下腔出血患者分别实施3D-CTA和3D-DSA检查,观察其临床效果,探究3D-CTA和3D-DSA的临床应用特点。方法从来我院诊治的2016年1月-2017年10月的自发性蛛网膜下腔出血患者中随机抽取90例,均进行3D-CTA和3D-DSA检查。结果在本研究中90例患者中,3D-CTA发现有9例阴性、71例颅内动脉瘤、3例烟雾病、5例动静脉畸形、2例硬脑膜动静脉瘘。3D-DSA发现有3例阴性、74例颅内动脉瘤、4例烟雾病、6例动静脉畸形、3例硬脑膜动静脉瘘。3D-CTA结果阴性病例而进行DSA检查为阳性的病例为:3例基底动脉动脉瘤、1例小脑动静脉畸形、1例侧窦硬脑膜动静脉瘘、1例椎动脉夹层动脉瘤。3D-CTA诊断自发性蛛网膜下腔出血的阳性率为90.00%低于3D-DSA阳性率(96.67%)(χ^2=11.632, P<0.05);在本研究中74例颅内动脉瘤进行3D-DSA检查动脉瘤有96个,具有65例单发动脉瘤的患者,9例多发动脉瘤患者;3D-CTA动脉瘤有87个,有9个漏诊,漏诊的动脉瘤都是夹层动脉瘤和微小动脉瘤。3D-CTA动脉瘤的检出率为100%高于3D-DSA(90.63%)(χ^2=13.245, P<0.05)。结论 3D-CTA和3D-DSA都可以准确诊断自发性蛛网膜下腔出血的病因,但是3D-DSA的诊断颅内动脉瘤的阳性率较高,有效降低颅内动脉瘤的漏诊率,值得临床广泛应用。Objective To observe the clinical effects of 3D-CTA and 3D-DSA in patients with spontaneous subarachnoid hemorrhage, and to explore the clinical application characteristics of 3D-CTA and 3D-DSA. Methods The data of ninety patients with spontaneous subarachnoid hemorrhage from January 2016 to October 2017 in our hospital were randomly selected for 3D-CTA and 3D-DSA. Results Among the 90 patients, the 3D-CTA was found: 9 cases were negative, 71 cases were intracranial aneurysms, 3 cases were moyamoya disease, 5 cases were arteriovenous malformations, and 2 cases were dural arteriovenous fistulas. And the 3D-DSA found: 3 cases were negative, 74 cases of intracranial aneurysms, 4 cases of moyamoya disease, 6 cases of arteriovenous malformations, and 3 cases of dural arteriovenous fistula. The 3D-CTA negative cases and DSA positive cases were: 3 cases basilar artery aneurysm, 1 cases cerebellar arteriovenous malformation, 1 case of lateral sinus dural arteriovenous fistula, 1 case of vertebral artery dissection aneurysm. The positive rate of 3D-CTA in the diagnosis of spontaneous subarachnoid hemorrhage was 90.00%, which lower than that in 3D-DSA (96.67%)(χ2=11.632, P<0.05);In this study, 74 cases of intracranial aneurysms were performed by 3D-DSA. There were 96 aneurysms, 65 patients with single aneurysms, 9 patients with multiple aneurysms, and 87 with 3D-CTA aneurysms. The missed diagnosis, missed aneurysms are dissection aneurysms and microaneurysms. The detection rate of 3D-CTA aneurysm was 100%, which higher than 3D-DSA (90.63%)(χ2=13.245, P<0.05). Conclusion The 3D-CTA and 3D-DSA could accurately diagnose the cause of spontaneous subarachnoid hemorrhage, but the positive rate of 3D-DSA diagnosis of intracranial aneurysms was higher, which could effectively reduce the rate of missed diagnosis of intracranial aneurysms.

关 键 词：3D-CTA 3D-DSA 自发性蛛网膜下腔出血 

分 类 号：R743.35[医药卫生—神经病学与精神病学]