血管造影在动脉瘤和动脉狭窄诊断中的应用研究

目的：观察CT血管造影（CTA）技术在动脉瘤和动脉狭窄诊断中的应用价值,优化CTA技术的三维重建方案。方法：选择临床拟诊为动脉瘤和动脉狭窄各15例,行CT平扫和增强扫描后进行数字减影,分别进行减影CTA（DSCTA）和常规CTA重建,比较两种重建方式的图像质量、动脉瘤检出率及对动脉狭窄的显示程度,观察两种技术敏感的血管区域。结果：对Willis动脉环及其远端的血管,常规CTA和DSCTA的图像质量均差异不显著（P〉0.05）,对Willis动脉环近端的血管,DSCTA的图像质量显著优于常规CTA（P〈0.05）;对Willis动脉环近端的血管,DSCTA的图像质量显著优于常规CTA（P〈0.05）;对于Willis动脉环近端血管动脉瘤,DSCTA检出率显著高于常规CTA（P〈0.05）;对于动脉狭窄,常规CTA过度诊断率为18.2%,显著低于DSCTA（P〈0.05）。结论：DSCTA对动脉瘤的检出率很高,适用于动脉瘤的筛查;常规CTA对动脉狭窄程度的判断较为准确。     

颅颈部血管多层螺旋减影CTA与DSA的比较研究

目的 评价减影CTA对检察颅颈部血管性病变的灵敏度和特异度及其临床应用价值.方法 对76例怀疑颅颈部血管疾病患者施行16层螺旋减影CTA检查,在保证增强前后所采集的数据参数一致的前提下用Neuro-DSA软件进行减影,其中30例与DSA作比较观察.减影CTA图像质量分为优良、一般、差;应用非参数统计检验、计算减影CTA显示病变的灵敏度和特异度.结果 以颈内动脉颅段、前后交通动脉、大脑前中后动脉近段、椎基动脉为观察对象,共观察血管段900段.减影CTA图像质量优良571段,为63.4%,一般有301段,为33.4%.但在显示颅颈部不同段血管的图像质量上有差异;减影CTA检出病变的灵敏度为84.4%,特异度为40%,检出动脉瘤的灵敏度和特异度均为100%.结论 16层螺旋减影CTA无创,快捷,简单易行,能提供较高分辨率的血管图像,可作为一种常规的方法应用于颅颈部血管疾病的筛查和诊断.     

减影CTA成像技术在脑动脉瘤诊断中的优势

目的合理应用64层螺旋CT减影CTA的优势,提高对脑动脉瘤的诊断率。资料与方法对61例临床有蛛网膜下腔出血的患者行CT检查,并用减影CTA和常规CTA进行对比,重组技术用最大密度投影(MIP)和容积再现(VR)。以手术及部分DSA为标准评价两种检查结果;由两名有经验的神经外科医师、两名放射科医师双盲法评价图像质量。结果减影CTA检出动脉瘤63个,检出动脉瘤的敏感性为100%、特异性为100%,阴性似然比为0.0000,评价者对动脉瘤检出的一致性为1.00;常规CTA检出动脉瘤60个,漏检3个颈内动脉床突下动脉瘤,检出动脉瘤的敏感性为95%,特异性为100%,阴性似然比为0.0500,评价者对动脉瘤检出的一致性为0.9565。结论减影CTA技术对颈内动脉床突下动脉瘤的检出具有明显的优势。     

数字减影CT血管成像对颅内小动脉瘤的诊断价值

目的：评价数字减影 CT 血管成像(DSCTA)在颅内小动脉瘤诊断中的价值。方法回顾性分析92例经数字减影血管造影(DSA)或手术确诊为颅内动脉瘤患者的临床及 CT 影像资料,比较 DSCTA 和常规 CT 血管成像(CTA)2种技术对颅内动脉瘤检测的准确性。结果92例患者经证实共有102个动脉瘤,DSCTA 检出其中100个,常规 CTA 检出其中89个(χ2=8.707,P =0.003)。DSCTA 漏诊海绵窦段和床突下段动脉瘤各1例,而常规 CTA 漏诊13例床突下段及海绵窦段与颅骨紧贴<5.0 mm 的小动脉瘤。进一步将<3.0 mm 和3.0~5.0 mm 的动脉瘤合并计算,DSCTA 对检出5.0 mm 以下动脉瘤的敏感性显著高于常规CTA 技术(χ2=8.393,P =0.004)。结论DSCTA 对颅内动脉瘤诊断优于常规 CTA,尤其对颅底毗邻小动脉瘤的诊断有明显的优势,可作为筛查和诊断颅内动脉瘤的首选检查技术。     

减影CTA与常规CTA技术在脑动脉瘤夹闭术后的对照

目的 评价减影CT血管造影(CTA)和常规CTA在脑动脉瘤夹闭术后随访中的应用价值. 资料与方法 34例经DSA证实的脑动脉瘤患者,在术后10天用64排螺旋CT血管造影行动脉瘤夹闭术后随访,评价脑动脉瘤夹闭术后减影CTA和常规CTA的图像质量. 结果 减影CTA显示瘤颈残余6例,漏诊1例动脉瘤颈夹闭不全,载瘤动脉狭窄2例.减影CTA对动脉瘤颈残留评价的敏感性、特异性分别为85.7%、100%,准确性为96.1%;对载瘤动脉狭窄的敏感性、特异性、准确性均为100%.常规CTA显示瘤颈残余5例,漏诊2例动脉瘤颈残余和误诊1例大脑中动脉近端闭塞;常规CTA对动脉瘤颈残留评价的敏感性、特异性分别为71.4%、100%,准确性为94.4%;对载瘤动脉狭窄的敏感性、特异性分别为100%、96.8%,准确性为97.1%. 结论 减影CTA检查准确性高,可作为动脉瘤夹闭术后随访的主要方法.     

CT减影技术诊断脑动静脉畸形的临床应用

目的 评价64排螺旋CT减影CT血管造影技术诊断脑动静脉畸形(AVM)的临床价值.方法 17例脑AVM患者行64排螺旋CT减影CT血管造影检查,对畸形血管团的数目、位置、范围、供血动脉的分布及引流静脉的方向等进行统计分析.结果 本组病例中减影CTA共发现17个病灶,与DSA和手术所见比较,1个直径1.2 cm的病灶被漏诊.减影CTA诊断脑AVM的敏感度、特异度及准确度分别为94.4%、100%、94.4%.减影CTA在显示细小供血动脉的清晰程度低于DSA,其判断脑AVM供血动脉的敏感度为83.0%.减影CTA对引流静脉的显示与DSA影像和手术所见一致. 结论 64排螺旋CT减影CTA可作为评价脑AVM的检查方法.     

64层螺旋CT与数字减影血管造影对颅内动脉瘤诊断的比较

目的 通过64层螺旋CT的CT血管造影(CTA)及CT数字减影血管造影(CTDSA)技术与数字减影血管造影(DSA)的比较研究,评价64层螺旋CT在颅内动脉瘤诊断中的临床应用价值。方法 26例临床怀疑颅内动脉瘤的患者实施64层CT和DSA检查,对64层CT图像进行了CTA和DSCTA两种方式的后处理。CTA后处理技术包括容积再现(VR),最大密度投影(MIP)和多平面重建(MPR),在CTA图像基础上用增强数据逐层减去平扫数据,自动去除骨与脑组织,获得CTDSA影像。比较3种技术(DSA、CTA和CTDSA)的特征。结果 26例可疑患者中,DSA和CTDSA发现31个动脉瘤,CTA发现29个动脉瘤。CTA漏掉的2个动脉瘤,直径小于3mm。结论 CTDSA是检查颅内动脉瘤的高度敏感的影像学方法,具有与DSA相当的价值。     

64层螺旋CT2种后处理技术在颅内动脉瘤检查中的应用

目的 探讨64层螺旋CT 2种后处理技术对颅内动脉瘤的诊断价值.方法 对58例临床高度怀疑动脉瘤患者CTA图像进行回顾性分析,由2位资深放射科医师对原始图像进行VR、MIP后处理,以手术或DSA结果为金标准,分别计算VR、MIP、VR+MIP后处理技术诊断颅内动脉瘤的敏感性、特异性、漏诊率.结果 CTA证实10例无动脉瘤,48例有动脉瘤,图像质量4分42例,3分12例,2分4例,1分0例.VR诊断颅内动脉瘤敏感性96.67%,特异度76.92%,漏诊率23.08%,Youden指数0.73;MIP诊断动脉瘤敏感性96.15%,特异度47.67%,漏诊率52.33%,Youden指数0.44.MIP+VR诊断动脉瘤敏感性96.77%,特异度83.33%,漏诊率16.67%,Youden指数0.80.结论 64层螺旋CT各种后处理技术的联合应用,可显著提高动脉瘤的诊断.     

64层螺旋CT数字减影术对头颈部动脉成像应用研究

目的:探讨64层螺旋CT数字减影技术对头颈部动脉成像的优势。方法:对25例怀疑头颈部血管病变患者行64层螺旋CT血管减影成像检查,用特殊头部固定装置固定头颅,先行平扫,然后以相同的扫描参数行增强扫描,将增强前后图像送至工作站进行减影,利用inspace从减影的图像中提取动脉,进行血管重组,其中15例同时行常规CTA检查,8例行DSA检查,比较减影CTA与常规CTA的成像速度、图像质量,并与DSA成像比较。结果:25例均能显示颈总动脉、颈内动脉、椎动脉及主要分支,其中17例颈椎及颅底骨质完全减去,血管显示良好,8例因检查时头部轻微动或做吞咽动作而造成部分颈椎骨及颅底骨未完全减去,但动脉仍能显示,减影CTA平均成像时间4.3min,常规CTA平均成像时间24.3min,2种成像技术比较,颈部动脉图像质量无明显差别,减影CTA对颅内动脉主干及更多分支的显示优于常规CTA,减影CTA与8例DSA比较图像完全相同。结论:64层螺旋CT血管减影技术省时省力、便捷灵活、图像质量好,值得在临床推广。     

数字减影和常规CTA在颅内动脉瘤诊断中的对照研究

目的:探讨多层螺旋CT(MSCT)数字减影和常规血管造影术在颅内动脉瘤诊断中的临床应用价值。方法:回顾分析本院56例可疑颅内动脉瘤患者,应用MSCT数字减影和常规血管造影术(简称减影和常规CTA)进行颅内动脉成像检查,全部患者均进行了手术确诊或DSA检查,并将两种检查结果进行比较。结果:全部患者中手术及DSA造影共检出动脉瘤65个,采用数字减影CTA共检出61个,敏感性为93.8%。常规CTA检出动脉瘤54个,敏感性为83.1%。结论:MSCT数字减影血管造影术是一种安全、无创的新型检查方法,具有较高的特异性及敏感性,明显优于常规CTA检查。     

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。     

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.     

16层螺旋CT血管造影在颅内动脉瘤中的应用价值

目的探讨16层螺旋CT血管造影(CTA)对颅内动脉瘤的诊断价值。方法28例疑有颅内动脉瘤患者均行16层CTA和DSA检查,对CTA的表现结合DSA和手术结果进行回顾性分析。结果本组28例经CTA共检出动脉瘤27个,其中25个经手术和DSA证实。1例CTA显示动脉瘤2个,DSA只显示1个,另1例CTA显示可疑动脉瘤2个,DSA显示正常。16层CTA诊断颅内动脉瘤的敏感性为89.2%,特异性为100%,准确性为96.4%。结论16层CTA在显示颅内动脉瘤方面可与DSA媲美,有重要临床应用价值。     

CTA对颅内微小动脉瘤的诊断价值并与DSA对照研究

目的：探讨16层螺旋CT血管成像和数字减影造影在颅内微小动脉瘤（VSD）诊断及治疗中的应用价值。方法：对843例原发性蛛网膜下腔出血的动脉瘤疑似患者行CTA和DSA检查。CTA后处理采用多平面重建（MPR）,最大密度投影（MIP）,容积再现（VR）。DSA常规摄正、侧位、双侧斜位片。结果：经手术及介入栓塞治疗证实39枚微小动脉瘤,CTA诊断36枚,DSA诊断35枚。减影后CTA与DSA比较,对瘤体直径≤3mm的VSA的判断,无明显统计学差异,敏感性为92.3%,特异性为85.7%,准确性为91.3%。结论：CTA诊断微小动脉瘤是一种可靠方法,在临床诊断上与DSA基本等同,在对临床治疗提供帮助上,CTA明显优于DSA。     

16层螺旋CT血管造影在颅内动脉瘤破裂中的临床应用

目的通过与DSA和手术对照,探讨16层螺旋CT血管造影（CTA）在颅内动脉瘤破裂的临床应用价值。资料与方法对33例动脉瘤性蛛网膜下腔出血（SAH）、脑出血患者进行回顾性分析,33例均使用16层螺旋CT进行了CTA检查,其中18例行DSA检查;6例DSA下介入治疗,27例开颅行动脉瘤颈夹闭术;将CTA与DSA和术中所见对照。结果33例中,CTA共发现动脉瘤36个,其中18例行DSA检查者中,CTA发现动脉瘤20个,DSA发现动脉瘤21个;CTA能够清晰显示动脉瘤瘤体（形态、指向、轮廓）、瘤颈的宽度、载瘤动脉及与颅骨之间的关系;与DSA和手术对照,CTA对动脉瘤的检出率为95．2％,对破裂动脉瘤的诊断敏感性和特异性均为100％。结论16层螺旋CT脑血管造影重组图像质量高,安全、快速、无创,可以作为颅内动脉瘤破裂首选的筛检方法。     

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.     

Detection and characterization of very small cerebral aneurysms by using 2D and 3D helical CT angiography

BACKGROUND AND PURPOSE: Many cases of subarachnoid hemorrhage are due to rupture of small cerebral aneurysms. Our purpose was to evaluate the usefulness of helical CT angiography (CTA) in the detection and characterization of very small (<5 mm) intracranial aneurysms. METHODS: One hundred eighty consecutive patients underwent CTA for suspected intracranial aneurysms. All aneurysms prospectively detected by CTA were confirmed by digital subtraction angiography (DSA) or at surgery. CT angiograms and digital subtraction angiograms were reviewed by two independent blinded radiologists who performed aneurysm detection, quantitation, and characterization using 2D multiplanar reformatted and 3D volume-rendering techniques. RESULTS: Fifty-one patients harboring 41 very small intracranial aneurysms were included in this series. Eighty-one percent (33 of 41 aneurysms) were 相似文献   

双源MSCTA对治疗复杂颅内动脉瘤的指导价值

目的：探讨64层双源CT血管成像对指导复杂颅内动脉瘤治疗的价值。方法：19例颅内动脉瘤患者行64层双源CTA和DSA检查,对瘤体大小和瘤颈宽度进行测量,并对瘤体形态显示和瘤体三维关系、瘤体光滑度、显示级别与总体情况进行质量评估。统计学方法采用配对t检验和秩和检验。结果：19例患者双源CT和DSA均检出20个动脉瘤。在瘤体大小测量结果方面：MIP、VR成像技术分别与MPR、DSA技术进行比较,差异均有显著性意义（P〈0.05）;MIP与VR成像技术之间、MPR与DSA技术之间差异均无显著性意义（P〉0.05）。在瘤颈测量方面：MIP、VR与DSA成像技术之间差异无显著性意义（P〉0.05）,但与MPR成像技术间差异有显著性意义（P〈0.05）。在瘤体形态显示与瘤体三维关系方面：VR与MIP图像间差异无显著性意义（P〉0.05）,VR与DSA、MIP与DSA之间差异具有显著性意义（P〈0.05）。在瘤体光滑度方面：MIP与DSA之间差异无显著性意义（P〉0.05）,VR与MIP、DSA之间差异有显著性意义（P〈0.05）。在显示级别方面：VR与MIP图像之间差异无显著性意义（P〉0.05）,DSA与VR、MIP之间差异均具有极显著性意义（P〈0.01）。总体质量方面各组之间差异均有极显著性意义（P〈0.01）。结论：64层双源CTA对指导复杂颅内动脉瘤手术治疗有重要价值。