多层CT血管成像与数字减影血管造影诊断颅内微小动脉瘤的比较

目的 探讨MSCTA对最大径≤3 mm颅内微小动脉瘤(IMA)的诊断价值.方法 回顾性分析连续826例可疑颅内动脉瘤患者的临床和影像资料.全部患者住院前(发病后2 h～4 d)均采用16层螺旋CT行MSCTA,全部颅内动脉瘤均经DSA、三维旋转数字减影血管造影(3DRA)或手术证实.MSCTA、DSA及3DRA等影像资料由2名放射科医师独立进行分析.以DSA或3DRA为标准,计算MSCTA诊断IMA的敏感性、特异性及准确度,采用Kappa分析,评价DSA或3DRA与MSCTA两种检查方法诊断颅内IMA的一致性.采用X~2检验分析IMA与非IMA患者多发动脉瘤的患病率.结果 826例可疑颅内动脉瘤患者中,788例为颅内动脉瘤患者,单发706例,多发82例,共发现889个动脉瘤,38例MSCTA、DSA或3DRA检查结果均为阴性.经DSA或3DRA检查证实,212例患者(271个动脉瘤)共有232个IMA.MSCTA检出229个IMA,假阳性1例,漏诊4个.以DSA或3DRA为标准,MSCTA诊断IMA的敏感性、特异性、准确度分别为98.3%(228/232)、97.4%(38/39)、98.2%(266/271).两种检查方法有较强的一致性(Kappa值为0.927,P<0.05).IMA与非IMA患者多发动脉瘤患病率分别为21.2%(45/212)、6.4%(37/576),差异有统计学意义(X~2=36.421,P<0.01).结论 MSCTA诊断IMA具有较高价值,鉴于MSCTA对IMA的检出达到≤3 mm水准,提出将颅内IMA影像大小界定从4～5 mm调整为≤3 mm.     

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。     

多层螺旋CT血管成像与DSA诊断脑动脉瘤的对比研究

目的通过与DSA和外科手术对比评价多层螺旋CT血管成像（CTA）对脑动脉瘤诊断的准确性。方法对471例临床怀疑为脑动脉瘤的患者全部行CTA和DSA检查。所有CTA及DSA图像由两位神经放射科医师独立进行分析评价。以DSA和外科手术结果作为参考标准计算多层螺旋CTA诊断脑动脉瘤的准确性。结果多层螺旋CTA诊断所有动脉瘤的敏感性、特异性和准确性分别是97.0%、98.3%和97.6%,阳性和阴性预测率分别是98.5%和96.6%。多层螺旋CTA对于动脉瘤检出的敏感性与DSA的结果差别没有统计学意义（P〉0.05）。结论多层螺旋CTA对于脑动脉瘤检出具有很高的敏感性、特异性和准确性,它在脑动脉瘤的筛选和诊断可以替代常规DSA检查。     

多层螺旋CT脑血管造影容积重建技术对颅内动脉瘤的诊断及临床应用价值

目的：探讨多层螺旋CT血管造影（MSCTA）容积重建（VR）技术对颅内动脉瘤的诊断及价值。方法：对37例临床怀疑颅内动脉瘤的患者进行MSCTA检查，其中6例另行DSA检查。全部患者CT扫描获得原始图像后采用VR技术对图像进行三维重建，10例同时采用最大强度投影（MIP）进行重建。结果：37例患者MSCTA共发现43个动脉瘤，其中多发动脉瘤5例（4例2个，1例3个）。VR图像上所测动脉瘤直径2.5—38mm。6例DSA患者发现6个动脉瘤，与CTA结果基本相符。结论：MSCTAVR技术是一种简便、微创而且相对可靠的诊断颅内动脉瘤的方法，对于指导手术或介入治疗颅内动脉瘤有重要价值。     

16层螺旋CT血管造影在颅内动脉瘤诊断中的应用

目的：研究多层螺旋CT血管造影诊断颅内动脉瘤的应用价值。方法：16层螺旋CT机对怀疑有顷内动脉瘤的28例患者行CTA裣查，将啄始数据输入Vitrca2工作站，重建颅内血管三维图像，进行多平面重建（MPR）、容积重建（VR）、最大密度投影法（MIP）等后处理，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28例33个动脉瘤，动脉瘤直径最小3mm，最大25mm。MSCTA能清晰显示动脉瘤的瘤体大小、瘤颈、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。27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。     

颅内动脉瘤的MSCTA诊断

目的:探讨64层螺旋CT血管成像(64-MSCTA)对颅内动脉瘤的诊断价值。方法:搜集经DSA和手术证实的颅内动脉瘤18例,所有的病例均行64层螺旋CT血管成像。分别用最大密度投影(MIP)、容积再现(VR)、多平面重组(MPR)法进行图像重组。13例行手术治疗,5例行DSA检查。结果:18例患者中MSCTA发现动脉瘤17个,其中大脑中动脉7个,大脑前动脉6个,大脑后动脉2个,颈内动脉2个。1例左侧颈内动脉瘤MSCTA漏诊,经DSA检查发现。MSCTA上动脉瘤显示直径3～20mm。MSCTA所发现的17个动脉瘤与手术及DSA所见的动脉瘤位置、大小、形态基本一致。结论:MSCTA能清楚显示颅内动脉瘤的形态、位置及其与周围的解剖关系,为手术或介入治疗动脉瘤提供有价值的信息。     

CTA与DSA诊断颅内动脉瘤的对比研究

目的通过与DSA对比,评价三维CT血管造影在颅内动脉瘤诊断中的价值。方法对30例因蛛网膜下腔出血高度怀疑动脉瘤破裂的病人行CTA检查,同期行DSA检查及可行的血管内栓塞治疗。比较CTA与DSA检出动脉瘤的敏感性、特异性和准确性以及在显示动脉瘤瘤颈和载瘤动脉关系上的优劣。结果CTA检出动脉瘤26个,对动脉瘤的敏感性为95.5%,特异性为87.5%,准确性为93.3%,与DSA比较无显著差异。CTA对动脉瘤细节及瘤颈的显示明显优于DSA。结论CTA能无创有效的诊断颅内动脉瘤,所提供的诊断信息对治疗方案的制订具有极大的帮助,CTA还特别适用于急症病人的动脉瘤筛查。     

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。     

3D—MSCTA诊断颅内动脉瘤的临床应用

目的探讨3D—MSCTA诊断颅内动脉瘤的临床应用价值。方法利用16层螺旋CT对25例临床怀疑颅内动脉瘤患者行三维血管成像，常规采用VR技术，并以MIP和MPR为辅助成像方法。结果25例共发现28个颅内动脉瘤，22例为单发，3例为多发（2个）。3 D—MSCTA所见病灶与手术结果或DSA所见相吻合。结论3D—MSCTA能清楚显示颅内动脉瘤的形态特征和周围解剖关系，且具有安全、快捷、无创等特点，可作为诊断颅内动脉瘤的首选检查方法。     

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。     

Multi-slice CT angiography of small cerebral aneurysms: is the direction of aneurysm important in diagnosis?

PURPOSE: Multi-slice CT (MSCT) has great potential in evaluation of vascular structures. Our purpose was to investigate if there is any difference in detection of superiorly, inferiorly and horizontally directed small cerebral aneurysms (<5 mm) on MSCTA compared to digital subtraction angiography (DSA) or surgery. MATERIALS AND METHODS: One hundred and three consecutive patients who underwent MSCTA and DSA or surgery were included in the study. MSCTA and DSA results were evaluated independently by two different neuroradiologists who performed aneurysm detection, quantitation, and characterization using 2D multiplanar reconstructions, 3D maximum intensity projection and volume-rendered techniques. FINDINGS: MSCTA detected 49 small cerebral aneurysms (<5 mm) in 37 (36%) of 103 patients. The overall sensitivity, specificity, and accuracy of MSCTA for detecting small aneurysms were 0.85, 0.65, and 0.79, respectively. There was moderate agreement between MSCTA and DSA/surgery for detecting small aneurysms (kappa: 0.51). The sensitivity of detecting small aneurysms directed superiorly, inferiorly and horizontally was 0.94, 0.84, and 0.75, respectively. There was no statistically significant difference in detection between small aneurysms directed superiorly, inferiorly and horizontally on MSCTA (P > 0.05). CONCLUSION: The direction of small cerebral aneurysms is not important in diagnosis on multi-slice CT scanners, although the detection of small cerebral aneurysms with superior or inferior direction is slightly easier than the detection of horizontally directed aneurysms.     

Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography

BACKGROUND AND PURPOSE: Four-section multisection CT angiography (MSCTA) accurately detects aneurysms at or more than 4 mm but is less accurate for those less than 4 mm. Our purpose was to determine the accuracy of 64-section MSCTA (64MSCTA) in aneurysm detection versus combined digital subtraction angiography (DSA) and 3D rotational angiography (3DRA).MATERIALS AND METHODS: In a retrospective review of patients studied because of acute symptoms suspicious for arising from an intracranial aneurysm, 63 subjects were included who had undergone CT angiography (CTA). Of these, 36 underwent catheter DSA; all but 4 were also studied with 3DRA. The most common indication was subarachnoid hemorrhage (SAH; n = 43). Two neuroradiologists independently reviewed each CTA, DSA, and 3DRA.RESULTS: A total of 41 aneurysms were found in 28 patients. The mean size was 6.09 mm on DSA/3DRA and 5.98 mm on 64MSCTA. κ was excellent (0.97) between the aneurysm size on 64MSCTA and DSA/3DRA. Ultimately, 37 aneurysms were detected by DSA/3DRA in 25 of the 36 patients who underwent conventional angiography. The reviewers noted four 1- to 1.5-mm sessile outpouchings only on 3DRA; none were considered a source of SAH. One 64MSCTA was false positive, whereas one 2-mm aneurysm was missed by CTA. The sensitivity of CTA for aneurysms less than 4 mm was 92.3%, whereas it was 100% for those 4–10 mm and more than 10 mm, excluding the indeterminate, sessile lesions.CONCLUSIONS: In comparison with the available literature, 64MSCTA may have improved the detection of less than 4-mm aneurysms compared with 4- or 16-section CTA. However, the combination of DSA with 3DRA is currently the most sensitive technique to detect untreated aneurysms and should be considered in suspicious cases of SAH where the aneurysm is not depicted by 64MSCTA, because 64MSCTA may occasionally miss aneurysms less than 3–4 mm size.

Aneurysms are one of the most important causes of subarachnoid hemorrhage (SAH), with a fatality rate between 40% and 60%, whereas misdiagnosis is associated with further increased morbidity and mortality.^1,2 Traditionally, catheter digital subtraction angiography (DSA) has been considered the “gold standard” for aneurysm detection; currently, 3D rotational DSA (3DRA; obtained via the catheter angiogram) may offer increased aneurysm detection, with improved visualization of an aneurysm''s configuration and contour compared with DSA alone.^3–6 However, the combination of DSA/3DRA is invasive, time consuming, and may involve neurologic complications in 1%–2%.^7,8 Hence, an accurate, noninvasive test would be invaluable in the emergent screening for SAH.In this regard, multisection CT angiography (MSCTA) has shown potential in the noninvasive detection of intracranial aneurysms. Recent literature has demonstrated a high accuracy of detecting aneurysms more than 3–4 mm in size using 4-section (4MSCTA) and 16-section (16MSCTA) in the ranges of 92%–100%, but with a much lower sensitivity in detecting smaller aneurysms (<3–4 mm), in the range of 74%–84%.^9–13 With the advent of newer, faster multidetector CT scanners, there can be thinner collimation, improved z-axis resolution, and contrast bolus timing, potentially leading to improved detection of these smaller aneurysms. Because there has been little literature comparing combined DSA/3DRA with 64-section MSCTA (64MSCTA), our purpose was to evaluate the accuracy of 64MSCTA in aneurysm detection with special attention to smaller (<4 mm) aneurysms.     

多层螺旋CT 三维血管造影容积重建成像在颅内动脉瘤中的诊断价值

目的探讨多层面螺旋CT三维血管造影(MS 3D-CTA)容积重建(VR)技术在颅内动脉瘤中的诊断价值.方法对109例临床怀疑颅内动脉瘤的病人行MS 3D-CTA和DSA检查.使用GE Lightspeed pro 16层螺旋CT扫描仪获得原始图像,所有病例均采用VR技术对图像进行三维重建,20例同时有最大密度投影(MIP)辅助检查.VR和MIP后处理图像以及DSA图像由3位放射科医生用双盲法进行分析.结果DSA和手术证实83例共94个动脉瘤,其中单发74例,多发9例(7例2个动脉瘤,2例3个动脉瘤).VR图像上所测动脉瘤大小为1.3～32 mm,与DSA比较无显著性差异(t=1.548,P＞0.05).VR对颅内动脉瘤的敏感度为96.8%,特异度为92.9%,准确度为95.9%,阳性预测值为97.8%,阴性预测值为89.7%;DSA敏感度为97.9%,特异度为96.3%,准确度为97.5%,阳性预测值为98.9%,阴性预测值为92.9%.94个动脉瘤中,89个(94.7%)动脉瘤在VR图像上能清晰显示瘤体、瘤颈与载瘤动脉的三维空间关系,DSA为57个(60.6%).结论MS 3D-CTA VR的敏感度、特异度和准确度均较高,是一种快捷、经济和有效的检查技术.     

Diagnostic accuracy of 3D time-of-flight MR angiography compared with digital subtraction angiography for follow-up of coiled intracranial aneurysms: influence of aneurysm size

BACKGROUND AND PURPOSE: 3D time-of-flight MR angiography (3D TOF MRA) may be used as noninvasive alternative to digital subtraction angiography (DSA) for the follow-up of patients with intracranial aneurysms treated with Guglielmi detachable coils (GDCs). We aimed to determine the influence of aneurysm size and location on diagnostic accuracy of 3D TOF MRA for follow-up of intracranial aneurysms treated with GDCs. MATERIALS AND METHODS: Two hundred and one 3D TOF MRAs in 127 consecutive patients with 136 aneurysms were compared with DSA as standard of reference. Sensitivity and specificity of 3D TOF MRA for detection of residual or reperfusion of the aneurysms was calculated with regard to aneurysm size and location. RESULTS: Overall sensitivity and specificity of MRA was 88.5% and 92.9%, respectively. Sensitivity was lower for aneurysms 相似文献   

CT angiography with three-dimensional techniques for the early diagnosis of intracranial aneurysms. Comparison with intra-arterial DSA and the surgical findings

INTRODUCTION: Cerebral CT angiography (CTA) is an established method applied to both the detection and treatment planning of intracranial aneurysms. The aim of our study was to compare CTA and digital subtraction angiography (DSA) findings with the surgical results mainly in patients with acute SAH and to evaluate the clinical usefulness of CTA. MATERIALS AND METHODS: During the last 2 years, 82 consecutive patients were admitted under clinical symptoms and signs suggestive of harboring an intracranial aneurysm. CT angiography performed immediately afterwards the plain CT, while DSA was performed within the first 48 h of admission. All aneurysms detected were confirmed during surgery or endovascular embolization. Repeat DSA was performed in all patients having both the initial CTA and the DSA 15 days after the onset of symptoms negative. CT angiograms and conventional angiographies were studied by a consensus of two radiologists for each technique, who performed aneurysm detection, morphological features characterization and evaluation of the technique. RESULTS: Surgical or/and endovascular treatment was performed in 45 patients and 53 aneurysms were confirmed. Using 3D-CT angiography, we detected 47 aneurysms in 42 patients. Conventional angiography depicted 43 aneurysms in 39 patients. The sensitivity of CTA for the detection of all aneurysms versus surgery was 88.7%, the specificity 100%, the positive predictive value (PPV) 100%, the negative predictive value (NPV) 80.7% and the accuracy 92.3%. Accordingly, the sensitivity of DSA was 87.8%, the specificity 98%, the PPV 97.7%, the NPV 89.1% and the accuracy 92.9%. Considering aneurysms > or =3 mm, CTA showed a sensitivity ranging from 93.3 to 100%, equal to that of DSA. CONCLUSION: Cerebral CT angiography has an equal sensitivity to DSA in the detection of intracranial aneurysms >3 mm. It has also 100% detection rate in AcoA and MCA bifurcation aneurysms, while some locations, like posterior communicating artery aneurysms, remain problematic. The delineating features of each aneurysm are better depicted with CTA due to 3D visualization. The use of digital subtraction angiography as a diagnostic tool can be limited in equivocal cases.     

颅内动脉瘤双源CT血管成像与常规和三维DSA结果的比较

目的 评价双源CT血管成像(DSCTA)在颅内动脉瘤诊断中的价值,并与常规和三维旋转DSA进行对照研究.方法 95例自发性蛛网膜下腔出血患者同时进行了DSCTA和DSA检查,用2种方法分别评价动脉瘤的检出率、形态、长轴及动脉瘤瘤颈/短轴(N/D)比值.动脉瘤N/D值比较采用配对t检验,长轴比较采用两相关样本的非参数检验.结果 95例患者,DSA在63例患者中检出67个动脉瘤,DSCTA在60例患者中检出64个动脉瘤,32例患者未检测到动脉瘤.DSCrA检测动脉瘤总的诊断敏感性、特异性、阳性预测值及阴性预测值分别为94.2%、100.0%、100.0%、91.4%.DSCTA对长径33 nnn动脉瘤的检出率与DSA一致,其诊断敏感性、特异性均为100%;长径＜3 mm动脉瘤的诊断敏感性和特异性分别为80.O%和100.0%.DSA与DSCTA所测动脉瘤N/D比值分别为0.46±0.14、0.51±0.18,差异无统计学意义(t=3.20,P＞0.05);长轴中位数分别为4.9、4.8 mm,差异也无统计学意义(Z=-1.309,P＞0.05).结论 DSCTA在诊断颅内动脉瘤方面与常规和三维旋转DSA相比有很高的敏感性和特异性.提高了小动脉瘤的检出率,可作为一种无创性的常规筛查方法.     

Comparison of 16-row multislice CT angiography with conventional angiography for detection and evaluation of intracranial aneurysms

Purpose

The aim of this study is to compare the diagnostic performance of 16-row computed tomographic angiography (MDCTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms in patients with nontraumatic subarachnoid hemorrhages (SAH).

Materials and methods

One-hundred and twelve consecutive patients with suspected intracranial aneurysm underwent both 16-row MDCTA and DSA. The MDCT angiograms were interpreted in a blinded fashion by using combination with VRI, MIP and MPR techniques. Sensitivity specificity and accuracy were calculated for the CTA and DSA. The results were compared with each other. The DSA reader's interpretation was accepted as the reference standard.

Results

A total of 164 aneurysms were detected at DSA in 112 patients, no aneurysms were detected by DSA and MDCTA in 16 patients. Eight aneurysms were missed by MDCTA. The overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 95.1%, 94.1%, and 95%, respectively. According to the size of the aneurysm less than 3 mm; sensitivity, specificity and diagnostic accuracy of MDCTA were 86.1%, 94.1%, 88.6%, respectively.

Conclusion

This study suggests that MDCTA is equally as sensitive as DSA in the detection of intracranial aneurysms of greater than 3 mm, and it also reveals 100% detection rate for ruptured 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。