单次对比增强双能量去骨CTA诊断颅内动脉瘤的价值

The Clinical Value of Single Contrast Enhanced Dual Energy Bone Removal CT Angiography in the Diagnosis of Intracranial Aneurysms

目的利用三维旋转数字减影血管造影(3D-DSA)为对照,评价双能量CT血管成像(DE-CTA)诊断颅内动脉瘤的价值。资料与方法46例临床怀疑颅内动脉瘤的患者同时行3D-DSA。以3D-DSA为对照,以患者和以部位为分析单位计算DE-CTA的诊断准确性。以相似的方法在3D-DSA和DE-CTA上测量动脉瘤长轴、短轴及瘤颈大小。结果3D-DSA证实11例无动脉瘤,35例有40个动脉瘤,动脉瘤平均长轴、短轴及瘤颈大小分别为(5.76±3.39)mm、(4.79±3.27)mm和(3.37±1.72)mm。DE-CTA正确检测了34例患者38个动脉瘤,漏诊2个动脉瘤。以3D-DSA为诊断标准,以患者和动脉瘤部位为分析单位,DE-CTA诊断动脉瘤的敏感性和特异性分别为97.1%、100%和95.0%、100%;诊断≤3 mm动脉瘤的敏感性和特异性分别为80%和100%。DE-CTA检测动脉瘤平均长轴、短轴及瘤颈大小分别为(5.54±3.48)mm、(4.50±3.31)mm和(3.11±1.67)mm;两种技术之间有很好的相关性(r=0.969、0.957、0.870;P=0.000)。结论与3D-DSA相比,单次对比增强DE-CTA在诊断颅内动脉瘤方面有很高的敏感性和特异性,是诊断颅内动脉瘤的有效方法。

Objective To evaluate the clinical value of dual-energy computed tomography angiography（DE-CTA）in the diagnosis of intracranial aneurysms compared with three-dimensional rotational digital subtraction angiography（3D-DSA）.Materials and Methods 46 patients clinically suspected of intracranial aneurysms underwent 3D-DSA.Accuracy of aneurysm detection with DE-CTA was analyzed on a per-patient and a per-aneurysm basis compared with 3D-DSA.The long,short axis and size of neck in aneurysms were measured with a similar fashion on DE-CTA and 3D-DSA.Resu-lts 11 patients（11/46）had no aneurysms,while 35 patients（35/46）had 40 aneurysms on 3D-DSA with the mean long,short axis and size of neck（5.76±3.39）mm,（4.79±3.27）mm,（3.37±1.72） mm,respectively.DE-CTA correctly detected 38 aneurysms in 34 patients,2 aneurysms in two patients were missed at the initial evaluation.Using DSA as the standard of reference,sensitivity and specificity of DE-CTA to detect intracranial aneurysms were 97.1% and 100% on a per-patient basis,95.0% and 100% on a per-aneurysm basis.DE-CTA had a sensitivity of 80% and a specificity of 100% for the detection of ≤3 mm aneurysms.On the DE-CTA,the mean long,short axis and size of neck were（5.54±3.48） mm,（4.50±3.31） mm,（3.11±1.67） mm,respectively.Excellent correlation was found between DSA and DE-CTA in the diagnosis of intracranial aneurysms（r=0.969,0.957,0.870,P=0.000）.Conclusion A single contrast-enhanced DE-CTA has a high sensitivity and specificity for the detection of intracranial aneurysms,it is a useful tool to evaluate intracranial aneurysms.