64层螺旋CT血管成像定位诊断硬脊膜动静脉瘘供血动脉及瘘口的应用初探

Locating the feeding artery and fistula of spinal dural arteriovenous fistula with 64-slice spiral CT angiography:initial experience

目的评价64层螺旋CT血管成像(CTA)在定位诊断脊髓硬脊膜动静脉瘘(SDAVF)供血动脉及瘘口的应用价值。方法24例经MRI诊断为SDAVF的患者随机分A、B两组。A组12例患者在DSA检查前行64层CTA检查,应用曲面重建技术,定位诊断硬脊膜动静瘘的供血动脉及瘘口,观察引流静脉在椎管内的分布状况,评估脊膜动静脉瘘累积脊髓的范围。B组为对照组,常规进行DSA检查,不进行CTA检查。A、B两组造影时间、对比剂用量、造影次数以及术后并发症进行对比分析。以DSA为金标准,计算CTA诊断的敏感度和特异度。结果A组12例全部完成造影,B组2例未完成造影。A/B两组患者平均造影时间47/92min,对比剂用量86/174ml,造影次数14/29次,术后并发症1/5例。CTA对供血动脉及瘘口诊断的敏感度为100%(12/12)、特异度为83.3%(10/12)。结论64层螺旋CTA定位诊断硬脊膜动静脉瘘供血动脉及瘘口为DSA检查提供了直观的影像资料,缩短了检查时间,减少了对比剂用量及曝光次数,降低了造影术后的并发症,是DSA检查前必要的辅助检查。

Objective To evaluate the value of 64-slice CT angiography （CTA） in locating the feeding artery and fistula of spinal dural arteriovenous fistula （SDAVF）. Methods Twenty-four patients with SDAVF diagnosed by MRI were divided into group A and group B randomly. Group A： CTA was performed in 12 patients before DSA, the feeding artery and fistula were located with curved planar reformation technique. Group B： DSA was performed in 12 patients directly. The examination time, dose of contrast media, angiographic times, complications of DSA were compared between the two groups. Regarding DSA as golden standard, the sensitivity and specificity of CTA were calculated. Results Average DSA examination time of A/B group was 47/92 min, dose of contrast media was 86/174 ml, angiographic times were 14/29, complications occurred in 1/5 patients. All patients completed examination in group A, but 2 patients failed in group B. The sensitivity and specificity of CTA were 100% （12/12）, and 83.3% （10/12）, respectively. Conclusion 64-slice CTA could show the feeding artery and fistula of SDAVF clearly, decrease the examination time and dose of contrast media significantly, reduce the complications of DSA.