探讨64排CTA诊断颅内动脉瘤的一致性

Consistency of 64-detector CTA diagnosis for intracranial aneurysm

目的评估64排CTA对颅内动脉瘤诊断价值的一致性。方法对34例自发性蛛网膜下腔出血(SAH)患者行MSCTA检查,由3名CT医师采用双盲法观察图像,描述动脉瘤特征,测量瘤体和瘤颈最宽径,并与DSA和手术对照。结果 MSCTA诊断颅内动脉瘤的平均敏感度和特异度分别为97.70%、85.71%;3 mm以下颅内动脉瘤平均敏感度和特异度分别为83.33%、85.71%。不同观察者、不同检查技术间MSCTA检出动脉瘤的一致性平均组内相关系数(ICC)分别为0.816、0.847。不同观察者、不同检查技术间MSCTA测量动脉瘤体的一致性平均ICC分别为0.913、0.942。不同观察者、不同检查技术间MSCTA测量动脉瘤颈的一致性平均ICC分别为0.770、0.808。同一观察者不同观察时间测量瘤体和瘤颈的一致性平均ICC分别为0.943、0.872。结论 MSCTA诊断颅内动脉瘤敏感性高、特异性强,且检出动脉瘤、测量瘤体及瘤颈的一致性较好,可明确SAH病因。

Objective To assess the inter-observers,inter-techniques and inter-time observer consistency of 64-detector CT angiography（CTA） for intracranial aneurysms.Methods Totally 34 patients with spontaneous subarachnoid hemorrhage（SAH） underwent both MSCTA and digital subtraction angiography（DSA）.Three radiologists reviewed CT images by double blind method.The features of aneurysm and the width of tumor body（D） and tumor neck（N） were described and measured.The sensitivity,specificity,and positive and negative predictive values for aneurysm detection with MSCTA were calculated according to DSA and surgical findings.Intraclass correlation coefficient（ICC） was also calculated to assess agreements of MSCTA.Results The mean sensitivity and specificity of MSCTA for intracranial aneurysms was 97.70% and 85.71%,respectively.For aneurysms less than 3 mm,the mean sensitivity and specificity of MSCTA was 83.33% and 85.71%,respectively.For the detection of aneurysms,the mean ICC of inter-observer and inter-technique was 0.816 and 0.847,respectively.For the measurement of tumor body,the mean ICC of inter-observer and inter-technique was 0.913 and 0.942,respectively.For the detection of tumor neck,the mean ICC of inter-observer and inter-technique was 0.770 and 0.808,respectively.For the detection of tumor body and tumor neck,the mean ICC of inter-time was 0.943 and 0.872,respectively.Conclusion MSCTA not only has high sensitivity and specificity for the detection of intracranial aneurysms,but also shows good consistency for the detection of aneurysms and the measurement of tumor body and neck.