头颈部双源CT血管成像诊断硬脑膜动静脉瘘的价值探讨

目的探讨头颈部双源cT血管成像（CTA）诊断硬脑膜动静脉瘘（DAVF）的价值。方法收集2009年6月至2012年6月8例DAVF患者的头颈部CTA资料，以8例性别及年龄相似的正常头颈部CTA为对照组，对比分析DAVF患者与正常头颈部CTA的征象差异，分析征象包括畸形血管的供血动脉数量，患侧硬膜窦边缘是否规整，有无异常穿颅血管通道，大脑皮层静脉是否扩张以及双侧颈内静脉密度是否对称等。结果多支（≥3条）供血动脉诊断DAVF的特异性、敏感性分别为88％、100％。患侧静脉窦边缘不规则的敏感性较低（50％），特异性很高（100％）。出现异常穿颅血管通道的敏感性较低（38％），特异性较高（88％）。DAVF组的双侧颈内静脉密度不对称性差异存在统计学意义（P=0．017）。结论头颈部双源CTA对诊断DAVF具有较高的价值，出现多支供血动脉、患侧静脉窦边缘不规则及双侧颈内静脉密度不对称高度提示DAVF。

Evaluation of dual-source CTA of head and neck in the diagnosis of dural arteriovenous fistula

Objective To analyze imaging features of dual-source CTA of head and neck with dural arteriove- nous fistula and investigate the value of dual-source CTA of head and neck in the diagnosis of dural arteriovenous fistula. Methods Eight patients with DAVF who underwent head and neck CTA from June 2009 to June 2012 were reviewed and collected CTA imaging data. Eight patients with DAVF and 8 age-and sex-matched control patients without DAVF composed the study group. The difference of head and neck CTA between DAVF and control group were comparativly analyzed. Number of the feeding artery, ＂irregular＂ appearance of dural venous sinus, transcalvarial venous channels, abnormal size of cortical veins,and symmetric attenuation of internal jugular vein were assessed. Results The presence of multi-arterial feeders showed good characteristics for the diagnosis of dural arteriovenous fistula,with a sensitivity of 88% and a specificity of 100% . An irregular sinus was highly specific： sensitivity of 50% and specificity of 100%. The presence of abnormal transealvarial venous channels demonstrated a poor sensitivity of 38%, but a high specificity 88%. CT attenuation of bilateral internal jugular vein showed statistically significant asym- metry in the DAVF group （P=0.017）. Conclusion Dual-source CTA of head and neck has a higher value in the diag- nosis of patients with DAVF. The signs of multi-arterial feeders, irregular sinus, and asymmetric internal jugular vein attenuation were highly suggestive of DAVF.