术前三维CT血管造影对颅内动脉瘤破裂出血的诊断及预后评估效能观察  

Efficiency of preoperative 3D-CTA for diagnosing rupture and hemorrhage of intracranial aneurysm and evaluation of prognosis

作　　者：时玉春 SHI Yuchun(Department of Medical Imaging,Kaifeng People's Hospital,Kaifeng,Henan 475002,China)

机构地区：[1]开封市人民医院医学影像科,河南开封475002

出　　处：《中国医学工程》2021年第1期58-60,共3页China Medical Engineering

摘　　要：目的探讨术前64排容积三维CT血管造影(3D-CTA)对颅内动脉瘤(IAN)破裂出血的诊断及预后评估效能的影响。方法选取2017年2月至2019年2月开封市人民医院收治的疑似为颅内动脉瘤破裂出血的92例患者,患者术前进行3D-CTA造影扫描,根据检测结果进行手术治疗,以显微神经手术所见的结果为金标准,将术前3D-CTA检查结果与手术所见结果情况进行对比。结果 92例患者中经手术所见确诊为破裂动脉瘤的有89例,其中3例为假性动脉瘤,89例患者共检测出98个动脉瘤,80例是单一动脉瘤,9例是多发动脉瘤(2个);动脉瘤具体分布:颅内前部动脉9个,颅内中部动脉22个,颅内后部动脉12个,颈动脉床突部3个,颈动脉虹吸段4个,颈动脉海绵窦部5个,前交通支动脉21个,后交通支动脉23个;3D-CTA检测出阳性85例,阴性7例,阳性检出率为92.39%,检测准确率为95.65%,3D-CTA的灵敏度为95.51%,特异度为100.00%;手术过程中发生脑梗死1例,脑血管痉挛2例,脑脊液漏1例,并发症发生率为4.35%;随访6个月后,动脉瘤复发1例,再出血1例,复发率为2.17%。结论 3D-CTA对IAN破裂出血的阳性检出率、准确率、灵敏度和特异度较高,手术并发症的发生率与术后IAN复发率较低,具有推广价值。【Objective】To investigate the effects of preoperative 64-slice CT angiography and 3D reconstruction(3D-CTA)on the efficiency in diagnosing rupture and hemorrhage of intracranial aneurysm(IAN)and evaluation of prognosis.【Methods】Ninety-two patients with suspected rupture and hemorrhage of IAN who were admitted to the neurosurgery department of the hospital between February 2017 and February 2019 were selected.All of them underwent 3D-CTA before operation and were treated with operation according to the results.With the results found by neurosurgical microsurgery as the golden standard,the results of preoperative 3D-CTA were compared with them.【Results】Of the 92 patients,89 were diagnosed as ruptured aneurysms by operation,including 3 with pseudoaneurysms.A total of 98 aneurysms were detected in the 89 patients,including 80 single aneurysms,and 9 multiple aneurysms(2).The corresponding numbers of aneurysms in intracranial anterior arteries,intracranial central arteries,intracranial posterior arteries,carotid sellar area,siphon carotid arteries,cartid-cavernous fistula,anterior communicating branches and posterior communicating branches were 9,22,12,3,4,5,21 and 23.3D-CTA detected 85 positive cases and 7 negative cases.The positive detection rate and detection accuracy were 92.39%and 95.65%.The sensitivity and specificity of 3D-CTA were 95.51%and 100%.During operation,there was 1 case of cerebral infarction,2 cases of cerebral vasospasm and 1 case of cerebrospinal fluid leakage,and the incidence rate of complications was 4.35%.After 6 months of follow-up,there was 1 case of recurrent tumor and 1 case of rebleeding,and the recurrence rate was 2.17%.【Conclusion】The positive detection rate,accuracy,sensitivity and specificity of 3D-CTA for rupture and hemorrhage of IAN are high.The incidence of surgical complications and postoperative recurrence rate of IAN are low.

关 键 词：64排容积CT血管造影 3D重建 颅内动脉瘤破裂 预后 

分 类 号：R651.12[医药卫生—外科学]