仿真3D-CT血管内镜对脑动脉瘤的诊断价值及临床意义

目的:评价应用仿真3D-CT血管内镜对以蛛网膜下腔出血(SAH)为首发症状的脑动脉瘤的诊断价值。方法:自发性SAH患者46例,均行多层面螺旋CT三维血管造影(3D-MSCTA)和数字减影血管造影(DSA)检查,31例接受手术治疗。3D-MSCTA采用遮盖容积重建(SVR)、多层面重建(MPR)和仿真3D-CT血管内镜(Fly-around、Fly-through)三种后处理技术。所得3D-MSCTA图像和DSA图像采用双盲法进行评价。结果:46例患者经Fly-around成像检出37例共有脑动脉瘤39个,经DSA和(或)手术证实均准确(真阳性),漏检1个动脉瘤(假阴性)。另9例SVR、Fly-around和DSA均未检出动脉瘤(真阴性)。敏感性为98%,特异性100%,准确性98%。用SVR成像共检出上述39个动脉瘤中的37个。DSA检出37例38个动脉瘤。SVR、Fly-around、DSA三者检出率分别为93%、98%、95%。它们之间的差异无统计学意义。Fly-through图像显示动脉瘤内附壁血栓形成6个。结论:仿真3D-CT血管内镜诊断脑动脉瘤敏感性高、准确性高,对疑诊脑动脉瘤者可首选3D-MSCTA检查,且应把仿真3D-CT血管内镜列为常规检查;仿真3D-CT血管内镜能显示动脉瘤腔内血栓形成。

Diagnostic value and clinical significance of virtual vascular 3D-CT endoscopic imaging of cerebral aneurysms

Objective:To evaluat the diagnostic value and clinical significance of virtual vascular 3D-CT endoscopy as a method for cerebral aneurysms in patients with spontaneous subarachnoid hemorrhage.Methods:46 patients who presented with spontaneous SAH,underwent both 3D-MSCTA and DSA.The reconstructed images were then processed into SVR,MPR,Fly-around and Fly-through images.Images of 3D-MSCTA and DSA were analysed,with assessment of 3D-MSCTA and DSA finding respectively.Results:A total of 39 aneurysms were detected in 37 patients by Fly-around image and were confirmed by DSA and/or operation method (true positives).The presence of cerebral aneurysms was excluded at SVR and Fly-around and DSA in 9 patients (true negatives).There were no false positives.Sensitivity was 98%,Specificity was 100%,diagnostic accuracy was 98%.37 aneurysms were demonstrated and 3 aneurysms were no detected by SVR.DSA revealed 38 aneurysms in 37 patients,The finding rate of the aneurysms of Fly-around and SVR and DSA was 98%,93% and 95%,respectively.There were no statistic differences among them.Intraluminal thrombus was detected in 6 singe aneurysm by virtual vascular 3D-CT endoscopy (Fly-through) and confirmed by MPR.Conclusions:Virtual vascular 3D-CT endoscopy is a high sensitivity and noninvasive method for detecting cerebral aneurysms.We suggest that 3D-MSCTA may be the first choice and virtual vascular 3D-CT endoscopy may be the regular method for diagnosing cerebral aneurysms;With 3D-CT endoscopic imaging,the intraluminal thrombus of the aneurysms could be demonstrated clearly.