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.

The Diagnostic Value of Multi - slice Three Dimensional Computed Tomographic Angiography with Volume Reconstruction in Intracranial Aneurysms

Objective To evaluate the diagnostic value of multi-slice three-dimensional computed tomographic angiography (MS 3D-CTA) with volume reconstruction (VR) in intracranial aneurysms. Methods MS 3D-CTA and DSA of 109 patients clinically suspected intracranial aneurysms were restrospectively analysed . Source images were got by GE Lightspeed pro scanner . VR was adopted to reconstruct 3D images in all cases and 20 of them aided by maximum intensity project ( MIP ) . Images of MS 3D-CTA and DSA were reviewed blindly and independently by 3 radiologists . Results A total of 94 aneurysms were verified by DSA and surgery in 83 patients . 74 patients had single aneurysm and 9 patients had multiple intracranial aneurysms ( 7 patients had two aneurysms and 2 had three aneurysms ) . There was no significant difference between DSA and CTA in size ranging from 1.3mm to 32mm (t=1.548,P>0.05 ) . For diagnosis of intracranial aneurysms by VR , sensitivity , specificity, accuracy, positive predictive value and negative predictive value were 96.8%, 92.9%, 95.9%, 97.8% and 89.7% respectively,while sensitivity , specificity, accuracy, positive predictive value and negative predictive value of DSA was 97.9%, 96.3%, 97.5%, 98.9%, 92.9% respectively. Of all 94 aneurysms, 3D spacial relationship of neck, body and parent artery of aneurysms could well demonstrated by VR in 89,while by DSA only in 57(60.6%). Conclusion MS 3D-CTA VR is a very quick ,economical and effective method in diagnosis of intracranial aneurysms and has very high sensitivity , specificity and accuracy.