3D -DSA 与 3D -256 层 螺旋 CTA 在 颅内动脉瘤检查中对比研究简

目的利用数字减影血管造影（DSA）旋转三维成像（3D-DSA）与三维256层螺旋CT血管造影对比（3D-CTA）.探索其对颅内动脉瘤（AN）（尤其是直径〈3mm的微小AN）的探测能力有无进一步的提高.以及3D-CTA与3D-DSA不同技术之间的对颅内AN检出率的一致性分析。方法临床表现高度怀疑为AN或磁共振血管造影（MRA）怀疑为AN56例患者.其中男性31例，女性25例；年龄38～78岁，平均年龄49岁。全部行头颈联合3D-CTA及3D-DSA检查：由2名影像医师盲法独立判读CTA图像，由1名神经介入医师和1名介入影像医师共同判读3D-DSA图像。以3D-DSA为“金标准”，评估3D-CTA的灵敏度、特异度及不同技术之间的一致性。结果3D-DSA在56例患者中的47例共检出59个AN病灶.其余9例未发现AN。3D-CTA检出AN54个，灵敏度为93-20％～94.90％（均值94.05％），特异度为81.8％。100.0％（均值90.9％）：对于AN病灶直径〈3mm，3D-CTA的灵敏度和特异度均值分别为86_4％和95.0％。对AN的检出.3D-CTA判读者之间及3D-CTA与3D-DSA不同技术之间一致性均为优（分别为K=0.847，均值K=0.802）：对于AN瘤体最大径的测量。3D-CTA判读者之间及3D-CTA与3D-DSA间差异均无统计学意义（P〉0.05）。结论3D-256层螺旋CTA对直径〈3mm的微小AN灵敏度和特异度均有所提高，判读者之间及与3D-DSA之间的一致性较高，可以作为疑似AN患者的首选筛查方法。两者联合可提高AN的检出率.为介入治疗AN提供可靠的影像学依据。

Comparison study on 3D-DSA and 3D-256-multislice CTA contrast research in inspection of intracranial aneurysms

Objective To compare digital subtraction angiography（I）SA） and three-dimensional rotational angiography（3D-DSA） with 256-muhislice 3D-CT angiography（CTA） in the detection and characterization of intracranial aneurysms（especially diameter 〈 3 mm）, and assess inter- technique and inter-observer reproducibility of 256-muhislice 3D-CTA for detection and evaluation of intracranial aneurysms. Methods From September 2011 to March 2013, a total of 56 consecutive patients with suspected aneurysm were enrolled, included 31 males and 25 females, who were aged 38 - 78 years old with a mean age of 49. All of them underwent both 3D-CTA and 3D-DSA. Two radiologists independently reviewed CT images, and 2 other radiologists reviewed 3D- DSA images. Using 3D-DSA as the ＂gold standard＂, the sensitivity, specificity, inter-technique and inter-observer reproducibility of 3D-CTA were assessed. Results The 3D-DSA revealed 59 aneurysms in 47 patients and non- aneurysm in 9. The 3D-CTA revealed 54 aneurysms, mean sensitivity and specificity of 3D-CTA for the detection ofintracranial aneurysms were 94.05 %（93.20 % - 94.90 %） and 90.9 %（81.8 % - 100.0 %）, respectively. For aneurysms 〈 3 mm, CTA had the mean sensitivity of 86.4 % and specificity of 95.0 %. Inter-technique and inter-observer agreements were excellent for detection of aneurysms （mean K = 0.802 and K=0.847, respectively）. For the measurement of aneurysm diameters, the results showed no statistically significant difference （P 〉 0.05）. Conclusion It is demonstrated that the 3D-256- muhislice CTA is an imaging method with good inter-observer reproducibility and high sensitivity and specificity for the detection and morphologic evaluation of ruptured intracranial aneurysms （especially diameter 〈 3 mm）. Combination of the 2 methods could improve the detection rate of eneurysm, and provide the reliable interventional radiological basis for eneurysm.