多层螺旋CT血管成像与三维重建在脑动脉瘤诊断中的应用价值

目的探讨多层螺旋CT血管成像与三维重建在脑动脉瘤诊断中的临床应用价值。方法对215例经手术或血管造影(DSA)证实的脑动脉瘤患者术前行螺旋CT血管造影容积扫描,运用最大密度投影(M IP)、多平面重组(MPR)、容积再现(VRT)、表面遮掩法(SSD)三维重建进行诊断。结果 215例病例成像清晰,DSA或手术(病例均行DSA检查、207例行手术)证实,215例共238个动脉瘤,其中CT血管成像(CTA)及三维重建正确诊断230个动脉瘤,漏诊8个动脉瘤,误诊1个动脉瘤,手术发现DSA漏诊3例共3个动脉瘤。其中M IP、MPR正确显示230个、VRT显示221个、SSD显示219个。本组CTA敏感性为96.6%,阳性预测值99.6%。CTA检查与DSA检查敏感性和阳性预测值无统计学差异(P>0.05)。结论多层螺旋CT脑血管成像与三维重建技术能较准确显示动脉瘤的位置、大小、形态,合理利用不同三维重建技术能提高脑动脉瘤诊断准确率,对临床术前评估及术后复查有重要临床价值。

The clinical value of multi-slice CT angiography and three dimensional technique in the diagnosis of intracranial aneurysm

Objective To evaluate the clinical value of CT angiography （CTA） in the diagnosis of intracranial aneurysms. Methods Two hundred fifteen patients with intracranial aneurysms confirmed by digital subtraction angiography （DSA） or surgery were included in this study. DSA, CTA and reconstruction of maximum intensity projection （ MIP）, multiplanar reconstruction （ MPR ）, volume rendering technique （ VRT）, shaded surface display （SSD） were executed in all cases. Surgery was performed in 207 cases. The results of CTA were compared with DSA and surgical findings. Results Two hundred and thirty - eight aneurysms in 215 cases were confirmed by DSA and surgery. Of 238 aneurysms, 230 in 206 cases were correctly diagnosed by CTA, 8 missed in 8 cases, and 1 misdiagnosed in one case. 230,230,221 and 219 aneu- rysms were demonstrated by MIP, MPR, VRT and SSD, respectively. Three aneurysms were missed by DSA examination according to operation results. Compared with DSA, the sensitivity and positive predictive value of CTA were 96.6% and 99.6% respectively. There was no statistics difference between CTA and DSA in the diagnosis of intracranial aneurysm. Conclusion CTA is a highly accurate imaging examination for the diagnosis of the location, size and characterization of intracranial aneurysms and it can provide sufficient diagnostic information in guiding the treatment of aneurysms.