128层螺旋CT数字减影血管成像对颅内动脉瘤的诊断价值

目的评价128层螺旋CT数字减影血管成像对颅内动脉瘤的诊断价值。方法60例临床怀疑颅内动脉瘤的患者分别进行128层螺旋CT数字减影血管成像（Digital subtraction angiography,DSACTA）和数字减影血管造影（DSA）,并对照手术或介入栓塞治疗结果评估其诊断价值。结果DSACTA共发现58例66个动脉瘤,其中52例为单个动脉瘤,4例为两个动脉瘤,2例多发动脉瘤。动脉瘤直径最小2mm,最大30mm。DSA检出60例68个动脉瘤,以DSA检出结果为金标准,128层螺旋CT数字减影血管成像,诊断符合率97．1％,2例2个小动脉瘤漏诊,漏诊率2．9％。结论DSACTA诊断颅内动脉瘤有较高准确性,可部分取代DSA造影检查。     

数字减影CT血管造影对颅内动脉瘤的诊断价值

目的 :探讨数字减影CT血管造影(digital subtraction CT angiography,DSCTA)对颅内动脉瘤的诊断价值。方法 :回顾性分析30例颅内动脉瘤合并自发性蛛网膜下腔出血患者的临床及影像学资料,并行MIP、VR观察动脉瘤。结果:30例共37个动脉瘤,前交通动脉6个,大脑前动脉2个,大脑中动脉9个,后交通动脉16个,基底动脉2个,颈内动脉2个。23例单发,7例多部位动脉瘤。DSCTA共发现35个动脉瘤,漏诊2个。动脉瘤大小3 mm×2.9 mm~12 mm×10 mm。18例行弹簧钢圈栓塞。7例行开颅夹闭术。DSCTA检查的敏感度为94.59%,特异度为100%,准确率为94.59%。结论:DSCTA是一种快速准确诊断颅内动脉瘤的非侵袭性检查方法,对颅内动脉瘤的检出具有极高的敏感性和特异性,为临床治疗方案的选择提供了可靠依据,有极高的临床价值。     

16层螺旋CT血管造影诊断颅内动脉瘤

目的:探讨16层螺旋CT血管造影(MSCTA)诊断颅内动脉瘤的准确性。材料和方法:30例临床怀疑颅内动脉瘤的患者分别进行16层螺旋CT脑血管三维成像(3D-MSCTA)和数字减影血管造影(DSA),所有病例均完成多层面重建(MPR)、三维表面遮盖显示(SSD)、容积显示(VR)和薄层块最大密度投影(MIP),并对照手术或介入栓塞结果评估其诊断价值。结果:MSCTA共发现24例28个动脉瘤,其中22例为单个动脉瘤,2例为两个动脉瘤。动脉瘤直径最小2.7mm,最大35mm。MSCTA能清晰显示动脉瘤的瘤体大小、瘤颈、瘤轴指向、载瘤动脉及其动脉瘤与临近血管分支和骨性组织间的空间关系。23例与手术/DSA结果一致。结论:MSCTA诊断颅内动脉瘤有较高准确性,可部分取代DSA造影检查。     

64层螺旋CT数字减影术对颅内动脉瘤诊断价值研究

目的 评价64层螺旋CT数字减影技术对颅内动脉瘤的诊断价值.方法 对36例蛛网膜下腔出血患者行64层螺旋CT平扫及增强扫描,每例患者均行常规CTA及减影CTA(digital subtraction CTA,DSCTA)重建,以DSA检查结果为标准,对比研究2种重建技术的图像质量、诊断准确性.结果 36例患者共计40个动脉瘤,经DSCTA检出动脉瘤40个,灵敏度、特异度分别为100%,经常规CTA检出动脉瘤37个,灵敏度、特异度分别为92.5%和100%.2组后处理图像质量单项有序行乘列表秩和检验有显著性差异(P＜0.01),DSCTA图像质量优于常规CTA.结论 64层螺旋CT DSCTA可作为筛查及诊断动脉瘤的首选方法.     

三维数字减影血管造影在颅内动脉瘤诊疗中的应用价值

目的：探讨3D—DSA在颅内动脉瘤诊断和治疗中的应用价值。方法：对蛛网膜下腔出血患者常规行DSA检查，发现病变或可疑病变后行3D—DSA检查。结果：26例颅内动脉瘤中检出动脉瘤31枚，其中后交通9枚，C1段3枚，C2段5枚，C3段3枚，前交通6枚，大脑中3枚。椎动脉动2枚。3例2D—DSA未见病变3D—DSA确诊，5例因血管重叠3D—DSA排除了动脉瘤。6枚GDC栓塞，5枚手术夹闭，2枚颈内动脉可脱性球囊封阻术。结论：3D—DSA极大提高了脑血管造影检查的准确性和可靠性，为动脉瘤的介入治疗和手术夹闭提供了可靠保障，在临床诊疗中具有很高的应用价值。     

64层螺旋CT血管分析软件对颅内动脉瘤诊断价值的研究

目的:评价64层螺旋CT血管分析(vessel analysis,VA)软件对颅内动脉瘤的诊断价值。方法:对40例蛛网膜下腔出血患者完成64层螺旋CT减影CTA增强扫描后,选取50段病变或可疑病变脑动脉分为两组:分别采用减影CTA图像和减影CTA图像+VA图像作诊断,诊断结果以DSA为准,比较2组诊断的特异性和敏感性。结果:减影CTA结合VA对颅脑动脉瘤诊断的特异性和敏感性均高于单独的减影CTA。VA对脑动脉瘤瘤颈显示效果优于减影CTA。结论:VA软件对颅内动脉瘤的诊断具有很大的临床价值。减影CTA结合VA的合理应用能更好的显示动脉瘤,提高动脉瘤的检查率,可作为筛查动脉瘤的首选方法。     

颅内动脉瘤的多层CT数字减影血管成像

目的:探讨多层CT数字减影血管成像(MSCT-DSA)诊断颅内动脉瘤的价值。材料和方法:临床怀疑颅内动脉瘤者行MSCT-DSA检查者36例,所有MSCTA检查均行最大密度投影、容积显示、多平面重建和仿真内镜重建。结果:MSCT-DSA对颅内动脉瘤诊断的检出率、敏感性、特异性和准确性均为100%,瘤体邻近颅骨完全分离率为100%,后处理时间为(9.3±5.4)min。结论:颅内动脉瘤的MSCT-DSA检查具有较好的临床价值。     

64层螺旋CT数字减影后造影对头颈部血管狭窄性疾病诊断价值

目的探讨数字减影后CT血管造影(DSCTA)在头颈部血管狭窄性疾病诊断中的价值及不足。资料与方法回顾性分析189例临床怀疑头颈部血管狭窄性疾病患者的临床及影像学资料。189例患者均接受64-MSC-TA检查,每例患者采用相同的技术参数先后进行平扫及增强扫描,原始数据传入工作站后进行自动减影,对减影后的数据进行三维容积再现(3D-VR)及多平面重组(MPR)、最大密度投影(MIP)等后处理,并对狭窄血管进行评估、诊断。其中60例患者在2周内接受了数字减影血管造影(DSA)检查,以其作为金标准,探讨DSCTA在头颈部血管狭窄性疾病中的诊断价值。结果 189例患者经MSCTA检查后128例示头颈部血管狭窄,其中60例经DSA检查对比,得出MSCTA诊断血管狭窄的敏感性96.5%、特异性99.3%、准确性98.6%、阳性预测值95.8%、阴性预测值99.8%。结论 DSCTA显示头颈部血管的图像优良,操作省时、方便,具有去除骨质、凸显血管的优点;尤其在头颈部血管狭窄性疾病诊断方面,可以替代DSA成为筛查、诊断及术后随访疾病的重要方法。     

64层CTA-MIP、CTA-VR与3D-DSA对颅内动脉瘤诊断价值的对比研究

目的对比评价64层螺旋CT最大密度投影(CTA-MIP),CTA容积再现(CTA-VR)与三维数字血管造影(3D-DSA)对颅内动脉瘤(CA)的诊断价值。资料与方法回顾性分析32例经手术及DSA确诊的CA 64层CT血管成像资料,并与DSA进行对照。结果 32例共40个动脉瘤,CTA-MIP发现35个动脉瘤,CTA-VR发现37个动脉瘤,3D-DSA发现39个动脉瘤。40个动脉瘤中11个位于后交通动脉,16个位于大脑中动脉,4个位于基底动脉,1个位于椎动脉,2个位于大脑前动脉,3个位于大脑后动脉,3个位于颈内动脉。3D-DSA与CTA比较,差异无统计学意义。结论在CA影像学诊断上,CTA-MIP、CTA-VR和3D-DSA各有优势,CTA可作为外科治疗或介入治疗的筛选方法。     

三维CT血管造影与平板DSA对颅内动脉瘤诊断价值的对比分析

目的 对比分析多层螺旋CT三维血管造影(3D-CTA)与平板DSA对颅内动脉瘤的诊断价值.方法 对44例自发性蛛网膜下腔出血(SAH)患者同时行3D-CTA及平板DSA(包括2D-DSA、3D-DSA)检查,评价不同检查方法对动脉瘤的诊断效能、3D-CTA容积再现(VR)与3D-DSA容积再现(VR)对共同检出的动脉瘤之瘤体长径差异、瘤颈及载瘤动脉清晰度.结果 44例自发性SAH患者经外科手术或血管内介入证实36例为动脉瘤患者,共46个动脉瘤(其中26例单发,10例多发).3D-CTA共检出40例48个动脉瘤(灵敏度83.33%,特异度75%,阳性预测值75%,阴性预测值66.67%).2D-DSA检出38例患者中44个动脉瘤(灵敏度77.78%,特异度75%,阳性预测值73.68%,阴性预测值75%).3D-DSA最大密度投影(MIP)检出34例动脉瘤患者共44个动脉瘤(灵敏度94.44%.特异度100%,阳性预测值100%,阴性预测值100%).3D-DSA(VR)检出36例动脉瘤患者共46个动脉瘤,无漏诊及误诊.就颅内动脉瘤的检出率方面,3D-CTA与2D-DSA、3D-DSA(MIP)的检出率差异无统计学意义(P>0.05),但3D-CTA(VR)与3D-DSA(VR)的检出率差异有统计学意义(P<0.05).无论是≥3 mm的动脉瘤还是<3 mm的动脉瘤,3D-CTA(VR)与3D-DSA(VR)对瘤体长径的测量差异均无统计学意义(P>0.1).在瘤颈及载瘤动脉清晰度显示方面,3D-CTA(VR)与2D-DSA和3D-DSA(VR)差异均有统计学意义(P<0.05),但3D-CTA(VR)与3D-DSA(MIP)差异无统计学意义(P>0.05).结论 3D-CTA对瘤体长径≥3 mm的颅内动脉瘤有很高的诊断效能,可作为一种微创的常规筛查方法,但对长径<3 mm的颅内动脉瘤有较高的漏诊及误诊率,对其未发现颅内动脉瘤的SSAH患者应进一步行3D-DSA检查.     

64层螺旋CT同步减影血管造影技术在颅内动脉瘤夹闭术后随访中的价值

目的:探讨64层螺旋CT(VCT)同步减影血管造影技术在颅内动脉瘤夹闭术后随访的价值。方法:对24例采用钛制动脉瘤夹的颅内动脉瘤患者,行64层螺旋CT同步减影血管造影(CTA),图像三维重建技术采用容积再现(VR)及最大密度投影(MIP)。结果:VCT同步减影血管造影技术可以清楚显示动脉瘤体消失,载瘤动脉与动脉瘤夹之间的关系以及动脉瘤夹的数量和位置。本组24例患者中显示动脉瘤夹27例,22例动脉瘤完全夹闭,2例动脉瘤术后仍显示部分瘤体。23例载瘤动脉通畅,1例有血管狭窄,所有患者未见动脉瘤夹滑脱移位征象。结论:VCT同步减影血管造影技术可以作为钛制动脉瘤夹闭术后随访的主要检查方法。     

Magnetic resonance angiography of intracranial aneurysms: comparison with intra-arterial digital subtraction angiography

Summary Magnetic resonance angiography (MRA) with flow rephased gradient-echo sequences is a new non-invasive method for vascular imaging. We compared MRA and intra-arterial digital subtraction angiography in 18 patients with intracranial aneurysms to test whether MRA presently provides an alternative to cerebral angiography for the diagnosis of these anomalies. MRA showed 19 of the 22 aneurysms detected (86.4%). However, problems, especially with turbulent or slow flow, resulted in 6 studies (27.3%) with limited and 2 with questionable demonstration of an aneurysm, and 1 false negative study. At present, MRA is definitely inferior to angiography for the demonstration of intracranial aneurysms, due to its lower resolution and other limitations.     

自发性蛛网膜下腔出血的CTA与DSA对比研究

目的:探讨64层CTA与DSA对自发性蛛网膜下腔出血(spontaneous subarachnoid hemorrhage,s-SAH)的应用价值及其限度。方法:收集153例s-SAH患者的CTA及DSA检查资料,回顾性分析2种检查方法的图像质量(采取1³分评分制),并比较2种方法在脑动脉瘤检出方面的灵敏度、特异度及准确度。结果:图像质量评分CTA为(2.63±0.262)分,DSA为(2.73±0.254)分,二者差异无统计学意义(P>0.05)。CTA对脑动脉瘤的检出的灵敏度为96.2%,特异度为94.9%,准确度为95.9%;DSA灵敏度为97.7%,特异度为97.4%,准确度为97.6%,二者差异无统计学意义(P>0.05)。结论:在s-SAH患者中,CTA与DSA均能准确检出动脉瘤所致破裂出血。相较于DSA,CTA能多方位显示病变,对血管壁及血管周围情况的显示更具价值。     

64层螺旋CT冠状动脉成像与冠状动脉造影的对比研究

目的评价64层螺旋CT冠状动脉成像诊断冠状动脉狭窄的准确性。方法 50例患者先后进行64层螺旋CT冠状动脉成像和冠状动脉造影检查,以冠状动脉造影为诊断冠状动脉疾病的"金标准",比较CT冠状动脉成像的符合率,评价64层螺旋CT冠状动脉成像诊断冠心病的准确性。结果 64层螺旋CT冠状动脉成像评价冠状动脉狭窄程度大于或等于50%的敏感性为98.6%,诊断狭窄程度小于50%的敏感性为87.0%,诊断冠状动脉狭窄的特异性为92.5%,阴性预测值为97.7%。结论 64层螺旋CT冠脉成像诊断冠状动脉狭窄有很高的准确率。     

Subtraction CT angiography for evaluation of intracranial aneurysms: comparison with conventional CT angiography

The purpose of our study was to compare the diagnostic performance of subtraction computed tomography angiography (CTA) with conventional nonsubtracted CTA and digital subtraction angiography (DSA) for the detection of intracranial aneurysms. A total of 76 patients underwent both subtraction CTA and conventional CTA for the detection and therapy planning of suspected intracranial aneurysms. Subtraction and conventional CTA images were independently assessed by two readers in a blinded manner. The possibility of endovascular treatment or surgical clipping was also assessed based on information provided by CT angiograms alone. In 64 patients, 75 aneurysms were present on DSA. On a per-aneurysm basis, the sensitivity of subtraction CTA was 98.6% for reader 1, and 100% for reader 2. However, sensitivity of conventional CTA was 94.6% for reader 1, and 93.3% for reader 2. Therapeutic decisions could be made regarding 63 patients based on information provided by subtraction CTA images. However, conventional CTA provided sufficient information to make this decision for 55 patients. Conventional CTA has limited sensitivity in detecting very small aneurysms as well as aneurysms adjacent to bone. Subtraction CTA performed on a 64-row multidetector CT is an accurate and promising diagnostic tool that seems to be equivalent to 2D DSA for the detection and pretreatment planning of intracranial aneurysms.     

CTA减影在颅内动脉瘤诊断中的应用价值

目的:评价CT血管造影(CTA)减影术在颅内动脉瘤诊断中的应用价值。方法:采用CT血管造影检查拟诊颅内动脉瘤33例,图像分别运用A(经减影后)及B(常规)进行两次三维(3D)成像:最大密度投影(MIP)、表面遮盖成像(SSD)、容积重建(VR)。以手术或随访为标准评价两种检查结果;由两位有经验的神经外科医生、两位放射科医生双盲法评价图像质量。结果:A法检出动脉瘤36个(三例患者为多发动脉瘤),显示瘤体、瘤颈、载瘤动脉和周围血管的关系清晰、确切。B法检出动脉瘤31个,漏检1个大脑前动脉瘤2、个前交通动脉瘤、2个颈内动脉瘤。A法的检出率为100%,B法的检出率为86%。两者检出率经χ2检验有统计学意义。结论:CTA减影3D成像对颅内动脉瘤的诊断优于常规3D。     

Three-dimensional volume rendering digital subtraction angiography in comparison with two-dimensional digital subtraction angiography and rotational angiography for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage

Objective

Subarachnoid hemorrhage (SAH), which can cause mortality and severe morbidity, is a serious condition whose underlying cause must be determined. We aimed to compare 2D digital subtraction angiography (2DDSA), rotational angiography (RA) and 3D volume rendering digital subtraction angiography (3DVRDSA) for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage.

Materials and methods

After an initial diagnosis of SAH with computed tomography, 122 patients (52 males and 70 females with a mean age of 47.77 ± 12.81 ranging between 20 and 83 years) underwent 2DDSA imaging, RA and 3DVRDSA imaging for detection of aneurysms. The location of the aneurysm, the best working angles, the dome/neck ratios, the largest diameter of the aneurysm, the shape of the aneurysm, the presence of spasms or pseudostenoses, and the relationship to the neighboring arteries were recorded.

Results

2DDSA missed 15.6% of the aneurysms that had a mean size of 2.79 ± 0.74 mm. RA was superior to 2DDSA for detecting aneurysm neck, and 3DVRDSA was superior to RA for detecting aneurysm neck. 3DVRDSA conclusively depicted the shape of the aneurysms in all patients. 3DVRDSA imaging was superior to 2DDSA and RA in the detection of the aneurysm relationship to neighboring arteries. The sensitivity and specificity of 3DVRDSA imaging for the detection of vasospasms were 100 and 84%, respectively.

Conclusions

3DVRDSA imaging is superior to 2DDSA and RA for detecting intracranial aneurysms and their morphological properties, especially those of small, ruptured aneurysms. However, 2DDSA should not be neglected in cases of vasospasm.     

Comparison of the accuracy of subtraction CT angiography performed on 320-detector row volume CT with conventional CT angiography for diagnosis of intracranial aneurysms

Objective

The accuracy of diagnosis of intracranial aneurysms by subtraction computed tomography angiography (CTA) was compared with conventional non-subtracted CTA and with digital subtraction angiography (DSA).

Methods

56 patients with spontaneous subarachnoid hemorrhage (SAH) and suspected intracranial aneurysms were evaluated from September 2009 to January 2010. All underwent 320-detector row volume CT-CTA examinations. Non-contrast CT of each patient's head with the same scan range was performed before the routine CTA scan as the mask image for subtraction. The subtraction CTA volume data was obtained by subtracting the mask image volume data from the conventional non-subtracted CTA volume data. Subtraction and conventional CTA volume data were transmitted to a VOXAR workstation and two physicians with experience in diagnostic imaging of the nervous system independently carried out image post-processing and judged the results. Neurosurgeons performed endovascular treatment or surgical clipping based on information available through the CTA alone.

Results

In 42 patients, 51 aneurysms were detected by DSA. On a per-aneurysm basis, the diagnostic sensitivity of subtraction CTA was 98.9% for physician 1 and 100% for physician 2. The sensitivity of conventional CTA was 93.7% for physician 1 and 92.6% for physician 2. There was excellent inter-observer agreement (κ = 0.84, 95% confidence interval 0.82–0.85). The overall sensitivity, specificity, positive predictive and negative predictive values of subtraction CTA were all 100%. The overall sensitivity, specificity, positive predictive and negative predictive values of non-subtracted CTA were 94%, 100%, 100% and 76%, respectively. Therapeutic decisions could be made for all 42 patients based on subtraction CTA images, whereas conventional non-subtracted CTA provided sufficient information to make therapeutic decisions for only 35 patients.

Conclusion

Conventional CTA has lower sensitivity for the detection of very small aneurysms and aneurysms adjacent to the skull when compared to subtraction CTA. Subtraction CTA performed on a 320-detector row volume CT is an accurate diagnostic tool that provides data equivalent to that obtained with three-dimensional-DSA for the detection of intracranial aneurysms.     

64层螺旋CT脑血管成像对颅内动脉瘤的临床诊断价值

目的:探讨64层螺旋CT脑血管成像(CTA)对颅内动脉瘤的临床诊断价值。方法:对55例临床怀疑颅内动脉瘤的蛛网膜下腔出血患者行64层螺旋CT脑血管成像检查,观察其原始图像及采用VR、MIP、MPR技术重建三维脑血管成像,部分病例同DSA或手术所见对照。结果:55名自发性蛛网膜下腔出血患者中,共检出动脉瘤患者47例,动脉硬化、狭窄3例,正常5例。CTA表现与手术结果、DSA基本一致。结论:64层螺旋CT脑血管成像能清晰的显示颅内动脉瘤的部位、大小、形态、瘤颈、与载瘤动脉及邻近血管及骨结构的关系,对颅内动脉瘤诊断敏感性及特异性较高,对绝大部分动脉瘤能迅速、准确地诊断,对临床治疗方案的制定有重要指导作用,并可作为术后复诊和随诊的重要手段。