16层CTA与DSA诊断颅内动脉瘤效能的对比研究

Values of 16-slice CTA and DSA in diagnosis of intracranial aneurysm

目的对比CTA与DSA诊断颅内动脉瘤的效能。方法首都医科大学附属北京天坛医院神经外科自2007年7月至2008年7月连续收治疑动脉瘤患者82例．均行DSA与CTA检查．确诊为动脉瘤患者行手术治疗。比较DSA、CTA检查的阳性率和二者诊断动脉瘤的特异性、敏感性和准确性，比较CTA检查与术中测量瘤体、瘤颈直径的大小，观察CTA、DSA检查对不同部位、大小动脉瘤的显示情况。结果CTA检出动脉瘤74个，DSA正确检出81个，二者阳性率差异无统计学意义（χ2=1．897，P=0．163）。以DSA检查结果为标准，CTA发现动脉瘤的灵敏性为91．4％（74／81），特异性为91．7％（11／12），准确性为91．4％（85／93）；65例患者行手术治疗，术中发现动脉瘤73个，以手术结果为标准，CTA、DSA检查的灵敏性比较差异有统计学意义（p〈0．05），特异性、准确性比较差异无统计学意义（P〉0．051；与术中测量的瘤体、瘤颈直径比较，CTA检查结果较大，差异有统计学意义（P〈0．05）；CTA检查对不同部位、大小动脉瘤的灵敏度不同，而DSA检查具有较高敏感性。结论16层CTA具有无创、快捷、敏感、高效等优点，可做为筛选动脉瘤的方法，部分患者可凭CTA指导手术。

Objective To assess the values of 16-slice CTA and DSA in the diagnosis of intracranial aneurysms. Methods Eighty-two patients with SAH, suspected having aneurysms and admitted to our hospital from July 2007 to July 2008, received DSA and CTA; the clinical data of these patients were analyzed; CTA images were compared blindly with the DSA findings, including the presence, location, and size of aneurysms. With SPSS 11.5 statistical software, the sensitivity, specificity and accuracy of CTA and DSA were compared. Results Eighty-one aneurysms were detected by DSA and 74 aneurysms by CTA; no significant difirences on the positive detected rate were noted （χ2=1.897, P=-0.163）. The sensitivity of CTA for detection of all aneurysms versus that of DSA was 91.4%, the specificity of CTA 91.7%, and the accuracy of CTA 91.4%. Sixty-five patients underwent surgery （clipping） and 73 aneurysms were confirmed by this surgery; CTA had a sensitivity of 89.0%, specificity of 100% and accuracy of 90.5%; DSA had a sensitivity of 98.6%, specificity of 84.6% and accuracy of 98.8%; significant statistical diference on sensitivity （χ2=5.625, P〈0.05） and no significant statistical diference on specificity and accuracy （χ2=1.846 and 2.450, respetively, P〉0.05） were found between them. As compared with the sizes of aneurysms and the diameters of aneurysm necks measured during the operation, these results detected by CTA were significantly larger （P〈0.05）. CTA had different detection sensitivities to aneurysms at different locations and with different sizes, while DSA had high sensitivity. Conclusion CTA is a noninvasive, quick, sensitive and efficient tool to diagnose inrtacranial aneurysms. It can be specially used to screen aneurysms in SAH patients. In some cases, CTA can guide the surgery.