数字减影CTA诊断破裂颅内动脉瘤的价值

目的:以3D-DSA为参考标准,探讨64层螺旋CT数字减影CTA对破裂颅内动脉瘤的诊断性能。材料与方法:所有病例经伦理审查委员会批准,患者或家属签订知情同意书。回顾性分析2012年1月至2013年11月期间的144例经过数字减影CTA和3D-DSA检查的动脉瘤性蛛网膜下腔出血(aneurysmal Subarachnoid Hemorrhage,SAH)患者。所有源图像都发送至后处理工作站进行三维重建及测量大小。以3D-DSA检查结果为标准,分别计算数字减影CTA诊断动脉瘤的敏感性、特异性。分别计算数字减影CTA诊断不同直径(<3 mm,≥3mm且<5 mm,≥5mm且<10 mm,≥10 mm)动脉瘤和前循环与后循环动脉瘤的敏感性、特异性。结果:144例患者中,DSA检查共发现199个动脉瘤,数字减影CTA发现196个动脉瘤。数字减影CTA检出的敏感性、特异性分别为98.5%和100%。<3 mm的敏感性和特异性分别为91.2%、100%;≥3 mm的分别为100%和100%。结论:64层CTA是颅内动脉瘤检出的可靠方法,可作为诊断动脉瘤性SAH患者的首选方法。

Detection value of ruptured intracranial aneurysms with digital subtraction computed tomographic angiography

Objective:To evaluate the diagnostic performance of 64-section DSCTA to detect ruptured intracranial aneurysms compared with 3D-DSA,as a reference standard. Materials and Methods:This study was approved by the institutional review board;written informed consent was obtained. One hundred and forty-four consecutive patients suspected of having aneurismal subarachnoid hemorrhage were recruited from January 2012 to November 2013. All patients underwent both 64-detector DSCTA and 3D-DSA for the detection of intracranial aneurysms. Source images were post-processed to reconstruct three-dimensional image and measure the aneuris-mal size. With 3D-DSA findings as the reference standard,sensitivity and specificity of digital subtraction CTA in depicting aneurysm were calculated. The sensitivity,specificity of DSCTA in depicting aneurysms of different diameter (ie,< 3 mm,≥3mm and <5 mm,≥5mm and <10 mm,≥10 mm) and of aneurysms at different locations in the anterior and posterior circulation were calculated. Re-sults:One hundred and ninety-nine aneurysms were seen in one hundred and forty-four patients. Of those,DSCTA detected 196. On a per-aneurysm basis,the sensitivity and specificity of CT angiography was 98. 5% and 100%,respectively. For aneurysms smaller than 3 mm,sensitivity was 91. 2%. However,the sensitivity and specificity were both 100% for aneurysms larger than 3 mm and all of ruptured intracranial aneurysms. Conclusion:64-slice DSCTA can be used as the primary screening method for patients who had aneurismal sub-arachnoid hemorrhage in the diagnostic routine.