多层螺旋CT与三维DSA重建成像对颈内动脉瘤构型分析的比较研究

目的探讨多层螺旋CT(multiple-slice spiral computed tomography angiography,MSCTA)和三维DSA(three-dimensional digital subtraction angiography,3D-DSA)重建成像在颈内动脉瘤构型分析中的意义,对比其在颈内动脉瘤诊断与治疗中的价值。方法回顾性分析91例可疑颅内动脉瘤患者的临床和影像资料,全部行MSCTA和3D-DSA检查,其重建成像显示颈内动脉瘤的三维空间构型,比较研究颈内动脉瘤的位置、形态、颈内动脉瘤瘤颈开口与载瘤动脉的连接方式、动脉瘤与颈内动脉及其分支血管开口的相互空间结构关系。并以3D-DSA重建成像结果为标准,计算MSCTA重建成像对诊断颈内动脉瘤的敏感性、特异性及准确度;采用Kappa分析评价MSCTA重建成像与3D-DSA重建成像两种诊断方法显示颈内动脉瘤的一致性;采用卡方检验分析检验MSCTA重建成像与3D-DSA重建成像两种诊断方法显示双泡及多泡型颈内动脉瘤的阳性率。结果 3D-DSA重建成像证实为颈内动脉瘤78例,其中单发59例,多发19例,共发现108枚动脉瘤;所有颈内动脉瘤可分型为三类:(1)单泡型动脉瘤74枚(68.52%)。(2)双泡及多泡型动脉瘤33枚(30.56%)。(3)梭型动脉瘤1枚(0.93%)。MSCTA重建成像检出颈内动脉瘤77例,单发58例,多发19例,共发现106枚动脉瘤;其中单泡型86枚(81.13%),双泡及多泡型19枚(17.92%),梭形动脉瘤1枚(0.94%);两者检查均为阴性13例。从另一个角度分析,所有颈内动脉瘤根据3D-DSA重建成像还可分型为:颈内动脉分支开口无关型动脉瘤、颈内动脉分支开口相关型动脉瘤和分支泡上发出型动脉瘤,分别有52枚、37枚和19枚;MSCTA重建成像显示的以上各型颈内动脉瘤分别是51枚、36枚和19枚;以3D-DSA重建成像为标准,MSCTA重建成像诊断颈内动脉瘤的敏感性、特异性、准确度分别为98.14%、92.86%、97.54%,两种检查方法有较强的一致性(Kappa=0.883,P<0.05)。3D-DSA重建成像显示双泡及多泡型颈内动脉瘤的阳性率为30.56%(33/108),高于MSCTA重建成像显示的阳性率17.92%(19/106),差异具有统计学意义(χ2=7.25,P<0.01)。结论 MSCTA重建成像为诊断颈内动脉瘤提供一个可靠的筛选、早期诊断的手段;而3D-DSA重建成像则清晰显示颈内动脉瘤的结构形态、动脉瘤与颈内动脉及其分支开口的空间结构关系,为制定合理的治疗方案提供了必要的可靠依据。

The comparison of MSCTA and 3D-DSA reconstruction imaging in diagnosis of internal carotid artery aneurysm

Objective To investigate the diagnosis and treatment values of MSCTA and 3D-DSA reconstruction imaging in the internal carotid artery aneurysm patients. Methods A retrospective analysis of 91 patients with the clinical data and imaging data of suspected intracranial aneurysms. All patients were underwent MSCTA and 3D-DSA examination. It was mainly show the three-dimensional conformation of the internal carotid artery aneurysm, mainly study of the location and shape of the carotid artery aneurysms and the connecting mode of internal carotid aneurysm neck opening with the parent artery and the＆amp;nbsp;classification of the internal carotid artery aneurysm. Study the sensitivity, specificity and accuracy of MSCTA in the diagnosis of carotid artery aneurysms using 3D-DSA as standard and the consistency of MSCTA reconstruction and 3D-DSA reconstruction using Kappa analysis. Study the positive rate of MSCTA and 3D-DSA in the diagnosis of double bubble and foam type internal carotid artery aneurysm using the chi-squared test analysis. Results Using 3D-DSA reconstruction 78 patients were found with internal carotid artery aneurysms, in which the single bubble patients were 59 cases, multiple bubble patients were 19 cases, 108 internal carotid artery aneurysm were found; the internal carotid artery aneurysm can be divided into three categories：（1） Single bubble type aneurysm were 74 cases accounting for 68.52%. （2） Double bubble and foam type aneurysm were 19 cases accounting for 17.92%. （3） Shuttle type aneurysm was 1 case, accounting for 0.93%. Using MSCTA reconstruction 77 patients with internal carotid artery aneurysms were detected, the solitary cases were 58, multiple cases were 19, 106 internal carotid artery aneurysms were found, in which the single bubble type were 86 cases, double bubble and foam type were 19 cases, aortic dissecting aneurysm was 1 case. From another perspective, according to 3D-DSA reconstruction all internal carotid artery aneurysm can be divided into carotid artery branch opening independent aneurysm, carotid artery branch opening related aneurysm and branch bubble from aneurysm, there were 52, 37 and 19 cases respectively;there were 51, 36 and 19 respectively according to MSCTA reconstruction;Taking 3D-DSA reconstruction as the standard, The sensitivity, specificity, accuracy of MSCTA reconstruction imaging in the diagnosis of internal carotid artery aneurysm of is 98.14%, 92.86%, 97.54%respectively. The strong consistency of two methods was observed（Kappa=0.883, P＆lt;0.05） The positive rate of 3D-DSA reconstruction imaging revealing double bubble and foam type internal carotid artery aneurysm was 30.56% （33/78）.It was higher than that of MSCTA reconstruction imaging （17.92%, 19/77）, the difference was statistically significant （χ2=7.25, P＆lt;0.01）. Conclusions MSCTA reconstruction imaging is reliable for screening and early diagnosis of internal carotid artery aneurysms;and 3D-DSA reconstruction imaging can reveal the type of the internal carotid artery aneurysm and the space structure relationship of the parent artery and its branches opening ICA. It is providing necessary basis for the reasonable treatment.