3D-CTA与DSA在颅内动脉瘤患者术前评估中的意义

The value of 3D-CTA and DSA in the evaluation of intracranial aneurysms before the operation

目的探讨三维CT血管造影(3D-CTA)及数字减影血管造影(DSA)在临床诊断颅内动脉瘤及术前评估中的意义。方法回顾性分析了我院自2006年以来76例疑似颅内动脉瘤患者的DSA、3D-CTA影像学资料,CTA处理后图像与DSA图像分别由两位神经外科医师及放射科医师采用双盲法进行分析。结果76例临床疑似患者仅58例经过手术及介入治疗证实为动脉瘤患者,共发现71个动脉瘤,其中单发动脉瘤47例,9例为2个动脉瘤,2例为3个动脉瘤。3D-CTA检查准确性为90.3%、敏感性为91.6%、特异性为98.6%,而DSA检查准确性、敏感性、特异性分别为95.8%、95.8%及100%。结论DSA诊断准确性及敏感性略高于3D-CTA,仍是颅内动脉瘤确诊的"金标准"。但后者具有安全、简便、快速、无创的优点,可清楚地显示解剖结构,是DSA检查的有力补充。两者联合应用有助于术前制定治疗策略,提高动脉瘤的诊治水平。

Objective To investigate the value of 3D-CTA and DSA in the diagnosis and evaluation of intracranial aneurysms before the operation. Methods The imaging data of 76 patients who were highly suspected for intracranial aneurysms in our hospital from 2006 were analyzed. Images of 3DCTA and DSA were blindly reviewed by two independent radiologists and neurosurgeons. Results Among the 76 suspected patients, 71 intracranial aneurysms of 58 cases were verified by surgery or the endovascular treatment. 47 patients had single aneurysm, 9 patients had 2 aneurysms and 2 had 3 aneurysms. For the 3D- CTA, the sensitivity, specificity, accuracy were 91.6%, 98.6%, 90. 3% respectively, and those of DSA were 95.8%, 100%, 95.8% respectively. Conclusion The accuracy, sensitivity of DSA were a little higher than 3D-CTA, it was also the ＂golden criterion ＂ in the diagnosis of intracranial aneurysms. But 3DCTA is the strongly supplement of the DSA because it is a simple, quick, non-invasive technique and can clearly delineate the aneurismal morphology. The combination of the two methods is helpful to make up the therapeutic strategy before operation and improve the curative effect in the diagnosis and treatment of in- tracranial aneurysms.