减影CTA成像技术在脑动脉瘤诊断中的优势

The Advantages of 64-row Computed Tomography Subtraction Angiography in the Diagnosis of Intracranial Aneurysms

目的合理应用64层螺旋CT减影CTA的优势,提高对脑动脉瘤的诊断率。资料与方法对61例临床有蛛网膜下腔出血的患者行CT检查,并用减影CTA和常规CTA进行对比,重组技术用最大密度投影(MIP)和容积再现(VR)。以手术及部分DSA为标准评价两种检查结果;由两名有经验的神经外科医师、两名放射科医师双盲法评价图像质量。结果减影CTA检出动脉瘤63个,检出动脉瘤的敏感性为100%、特异性为100%,阴性似然比为0.0000,评价者对动脉瘤检出的一致性为1.00;常规CTA检出动脉瘤60个,漏检3个颈内动脉床突下动脉瘤,检出动脉瘤的敏感性为95%,特异性为100%,阴性似然比为0.0500,评价者对动脉瘤检出的一致性为0.9565。结论减影CTA技术对颈内动脉床突下动脉瘤的检出具有明显的优势。

Objective To evaluate the advantages of 64-row computed tomography subtraction angiography in the diagnosis of intracranial aneurysms. Materials and Methods 61 patients who suffered from subarachnoid hemorrhage received CT examination; the CTA and subtraction angiography techniques including MIP and VR were used to evaluate the cerebral arteries, respectively. Two senior neurosurgical and radiological doctors reviewed the reconstructive results independently and compared the results with surgery or DSA. Results By the subtraction angiography technique, 63 intracranial aneurysms were detected in 55 cases, the sensitivity, specificity and negative likelihood ratio for detecting aneurysms on CTA were both 100%, 0.0000 respectively. Inter-observer agreements were 1 respectively. However, the CTA technique detected 60 lesions and 3 lesions were missed in anterior clinoid process of internal carotid artery, the sensitivity, specificity and negative likelihood ratio were 95% , 100% and 0.0500 respectively. Inter-observer agreements were 0. 9656 respectively. Conclusion Subtraction angiography technique has marked advantage in detecting the aneurysm in anterior clinoid process of internal carotid artery.