MSCTA 动态图像后处理对颅脑非典型 血管出血性病变的诊断价值

目的 探讨多层螺旋CT 血管成像（MSCTA）动态图像后处理对颅脑非典型血管出血性病变的 诊断价值。方法 选取2008 年1 月—2016 年3 月于西南医科大学附属医院因出血性脑血管病行头部CT 血 管造影（CTA）常规图像后处理未见明显血管性病变患者。通过变换容积重建、最大密度投影的阈值及角度 等进行动态图像后处理，采用Kappa 一致性检验评价各医师对动态图像后处理分析结果的可重复性，将结果 与数字减影血管造影（DSA）及手术探查结果进行比较。结果 共纳入56 例患者，动态图像后处理发现血 管出血性病变患者51 例，其中动脉瘤20 例、动静脉畸形25 例、静脉畸形4 例、动脉畸形伴动脉瘤2 例。2 名医师诊断的结果基本一致（P <0.05），CTA 动态图像诊断的敏感性为100%（95% CI ：92.59，100.00），特异 性为62.5%（95% CI ：30.57，86.32）。结论 MSCTA 动态图像后处理对颅脑非典型血管出血性病变分析过程 具有较好的重复性，与DSA 及手术探查相比结果具有较好的一致性，该方法具有较好的诊断效能，值得临床 推广。

The value of the MSCTA angiography dynamic image post-processing for atypical hemorrhagic cerebrovascular diseases

Objective To evaluate the diagnostic value of multi-slice spiral CT (MSCT) angiography dynamic image post-processing in the diagnosis of atypical hemorrhagic cerebrovascular lesions. Methods The cases diagnosed with hemorrhagic cerebrovascular disease that received CT cerebral angiography (CTA) and diagnosed with no obvious hemorrhagic cerebrovascular lesions by the general images post-processing were collected from January 2008 to March 2016. The images were dynamic post-processed again via changing threshold and angles of the VR, MIP. Kappa consistency test was used to evaluate the reproducibility of the results of dynamic image postprocessing analysis. The results were compared with Digital Subtraction Angiography (DSA) and surgical exploration results. Results A total of 56 patients were enrolled. 51 cases of hemorrhagic vessel lesions were found after dynamic image post-processing, including 20 aneurysms, 25 arteriovenous malformations, 4 venous malformations and 2 arterial malformations. The diagnosis results by the two physicians were basically same (Kappa value=0.778, P < 0.05). The sensitivity of CTA dynamic image diagnosis was 100% (95% CI: 92.59, 100), and the specificity was 62.5% (95% CI: 30.57, 86.32). Conclusions MSCTA dynamic image post-processing has a good repeatability for the analysis of atypical hemorrhagic cerebrovascular lesions. Compared with DSA and surgical exploration, the results of the MSCTA dynamic image post-processing have good consistency. The method has good diagnostic efficacy, which is worthy of clinical application.