双源CT血管成像检出内脏动脉瘤的临床意义

Clinical relevance of dual source CT angiography in the detection of visceral artery aneurysms

目的：定量评价双源CT增强横断面图像和CT血管成像后处理技术在内脏动脉瘤检出中的意义。材料与方法：回顾性分析2009年5月~2010年4月经双源CT血管成像检出的内脏动脉瘤14例,2名有经验的放射科医师共同评价,以先横断面图像后阅读后处理图像的顺序共同分析了所有图像,预先知道这些患者有动脉瘤,但不知道其部位及数目。记录动脉瘤的部位及数目,若1条血管发现1个或多个动脉瘤,即为阳性。以综合诊断为参照标准,以血管为分析单位,评价横断面和后处理图像检出内脏动脉瘤的诊断敏感性。记录分析横断面图像和后处理图像的时间有无差别。结果：14例患者中,综合诊断23条血管有动脉瘤,61条血管无动脉瘤。以综合诊断为参照标准,横断面图像正确诊断17条血管有动脉瘤,4例假阳性,6例假阴性,57条真阴性;对应于诊断敏感性和特异性为74%、93%。后处理图像观察到所有动脉瘤,对应于敏感性和特异性为100%和100%。相比于后处理图像,横断面增强图像漏诊或误诊了较多的小动脉瘤。分析横断面图像的时间[（58.5±15.6）s]也明显长于分析后处理图像[（30.6±8.2）s]的时间（P〈0.001）。结论：双源CT血管成像,尤其是VR和MIP技术能很好显示内脏动脉瘤的形态、位置和数目,尤其对小动脉瘤的显示有重要价值;对确立临床诊断和患者的处理有重要价值,且能节省读片时间。

Objective：To quantitatively evaluate the clinical value of contrast-enhanced axial CT images and post-processing CT images at dual source CT in the detection of visceral artery aneurysms.Methods：Fourteen patients with visceral artery aneurysms demonstrated by dual source CT angiography were retrospectively analyzed.Two well-experienced radiologists evaluated the axial and post-processing images,they knew the patients＇ history but not the location and numbers of aneurysms.Location and numbers of aneurysms were recorded if one or more aneurysms in a vessel were found,it was regarded as positive.With the comprehensive diagnosis as reference standard,the sensitivity and specificity of enhanced axial images and post-processing images to detect aneurysms were calculated.The time to draw a conclusion for the enhanced axial images and post-processing images was recorded and analyzed.Results：Of the 14 patients,aneurysms were found in 23 vessels and 61 vessels had no aneurysms.With the comprehensive diagnosis as reference standard,axial images correctly diagnosed 17 vessels with aneurysms,4 false positive vessels,6 false negative vessels,and 61 true negative vessels,corresponding to sensitivity and specificity of 74% and 93%.Post-processing images correctly diagnosed all aneurysms in 23 vessels and 61 vessels have no aneurysms,corresponding to sensitivity and specificity of 100% and 100%.Axial images under-or over-diagnosed more aneurysms than post-processing images.The analyzing time of axial images[（58.5±15.6）s] was longer than that[（30.6±8.2）s] of the post-processing images（P0.001）.Conclusions：Dual source CT angiography,especially VR and MIP,can clearly visualize the morphology,location,and number of visceral artery aneurysms.It has an important value in the detection of small aneurysms and definitive diagnosis and clinical management and saving reading time.