容积CT数字减影血管造影诊断颅内动脉瘤的价值及影响因素

目的 探讨容积CT数字减影血管造影(VCTDSA)检出颅内动脉瘤的影响因素。方法 回顾性分析204例自发性蛛网膜下腔出血(SAH)患者的临床、VCTDSA及3D-DSA资料,观测颅内动脉瘤的数量、位置、大小、颅内血管情况及减影后颅底骨质去除效果,计算VCTDSA诊断颅内动脉瘤的敏感度、特异度、阴性及阳性预测值,分析影响VCTDSA颅内动脉瘤诊断的相关因素。结果 204例SAH患者中3D-DSA共检出178例246个颅内动脉瘤,VCTDSA共检出180例248个颅内动脉瘤,其中多发动脉瘤51例119个。以3D-DSA为金标准,VCTDSA因血管痉挛及载瘤动脉解剖变异漏诊2个动脉瘤,因头部运动、血管痉挛及部分容积效应误诊4个动脉瘤。VCTDSA诊断颅内动脉瘤的敏感度、特异度、阳性预测值、阴性预测值分别为99.17%(244/246)、84.62%(22/26)、98.39%(244/248)、91.67%(22/24)。VCTDSA对最大径≤3 mm的颅内动脉瘤的敏感度为96.72%(59/61);对>3 mm的颅内动脉瘤敏感度为100%(187/187)。结论 VCTDSA对颅内动脉瘤的诊断效能与3D-DSA相似;动脉瘤的大小、血管痉挛、载瘤动脉解剖变异及检查时的头部运动是影响VCTDSA诊断颅内动脉效能的主要因素。

Value and factors affected efficiency of volume computed tomographic digital subtraction angiography in diagnosis of intracranial aneurysms

Objective To explore the value of volume computed tomographic digital subtraction angiography (VCTDSA) in diagnosis of intracranial aneurysms. Methods The clinical data, VCTDSA and 3D-DSA data were analyzed retrospectively in 204 subarachnoid hemorrhage patients. The number, position, size of intracranial aneurysm, and intracranial vascular condition, effect of skull removal were measured. The sensitivity, specificity, positive predictive value and negative predictive value of VCTDSA in detecting aneurysm were calculated, and possible factors that affect diagnostic efficiency of VCTDSA were analyzed. Results Totally 246 aneurysms were detected by 3D-DSA in 178 patients, 248 aneurysms were detected by VCTDSA in 180 patients, there were 119 multi-aneurysms in 51 patients. VCTDSA missed 2 aneurysms due to vasospasm and anatomical variations of their parent arteries, and misdiagnosed 4 aneurysms due to head movement, vasospasm and partial volume effect. The sensitivity, specificity, positive predictive value and negative predictive value of VCTDSA in detection of aneurysm were 99.17% (244/246), 84.62% (22/26), 98.39% (244/248), 91.67% (22/24), respectively. The sensitivity of VCTDSA was 96.72% (59/61) for aneurysms less than 3 mm, and 100% for those were more than 3 mm. Conclusion There is no statistical significance between VCTDSA and 3D-DSA in detection of aneurysm. Anatomical variations of parent arteries, size of the aneurysm, vasospasm and head movement during the examination can affect the efficiency of VCTDSA in the diagnosis of intracranial aneurysms.