多层螺旋CT在颅内动脉瘤评价中的应用

Evaluation of Intracranial Aneurysms with 16-Section CT Angiography

目的通过与数字减影血管造影（DSA）和（或）外科手术的对比研究,探讨MSCTA在颅内动脉瘤评价中的临床应用价值。方法对65例临床怀疑有颅内动脉瘤的患者进行MSCTA和DSA检查,CTA后处理技术包括多平面重建（MPR）、最大密度投影（MIP）和容积重建（VRT）等。CTA和DSA分别由相互独立的放射科医师实施和诊断分别记录动脉瘤的位置、大小、形态以及与周围动脉的关系。结果DSA和（或）外科手术在53例患者中共发现61个动脉瘤（真阳性和假阴性）。CTA发现55例63个动脉瘤,被DSA和（或）外科手术证实的动脉瘤57个（真阳性）,漏诊4个动脉瘤,未被DSA和（或）外科手术证实的动脉瘤6个（假阳性）。CTA诊断直径〈3mm、3～10mm和〉10mm的动脉瘤敏感度分别为84%、95%和100%,在疑似患者中发现动脉瘤的敏感度、特异度和准确度分别为88%、62%和87%。结论MSCTA是检查颅内动脉瘤高度敏感的无创影像手段,它可以作为颅内动脉瘤筛查和术前评估的首选技术。

Objective To evaluate the value of Multi - Section CT angiography（MSCTA） in the detection and characterization of intracranial aneurysms compared with digital subtraction angiography （DSA） and （or） surgery. Methods Total 65 patients who were suspected as harboring intracranial aneurysms by referring physicians underwent both CTA and DSA. 3D postprocessing techniques included MPR,MIP and VRT. 3D - CTA and DSA were performed and reviewed by two independent blinded radiologists. The presence, location, size and shape of the detected aneurysms were outlined. Presence of a neck and relationship of the aneurysms to adjacent arterial branches was also configured. Results In our series ,when using intra -arterial digital subtraction angiography or surgery ,61 aneurysms （ true positive and false negative） were found in 53 of the 65 patients. 63 aneurysms were detected in the 55 patients by CTA,a total of 57 aneurysms （true positive） were confirmed by DSA or surger, or both. 4 aneurysms were missed when using CTA. 6 aneurysms were not confirmed by DSA. And were considered to be false positive evaluations. The sensitivity for detecting aneurysms 〈 3mm,3～10 mm and 〉 10 mm on a per - aneurysms basis was 84% ,95% ,and 100% ,respectively. The sensitivity, specificity,and accuracy of CTA for detecting aneurysms on a per -patient basis were 88% ,62% ,and 87% ,respectively. Conclusion MSCTA has a high sensitivity of intracranial aneurysms, and it is noninvasive,it may be proposed as a first choice modality for screening and preoperative assessment for intracranial aneurysms.