DECTA对颅内微小动脉瘤的诊断价值

The Value of DECTA in Diagnosis of Intracranial Micro-aneurysms

目的探讨双源64层DECTA对颅内微小动脉瘤(IMA)(直径≤3 mm)的诊断价值.方法收集DSA或手术证实,并在1周内行DECTA及DSA检查的37个颅内微小动脉瘤.结果 DECTA检出34个,假阳性1个,漏诊4个,3D-DSA检出36个,假阳性0个,漏诊1个.以DSA为标准,DECTA检出微小动脉瘤(IMA)的敏感性、特异性、准确性分别为91.6%、100%、91.9%.VE显示:动脉瘤清楚显示弓形隆起且内壁清晰者22个(含2个钙斑),可见弓形隆起并内壁不光滑者15个(含9个软斑,6个钙斑),规则的钙斑在VE上内壁显示可以是光滑的隆起,与无斑块者内壁区分欠佳,无斑块者和软斑者在VE上内壁显示和MIP的血管外壁形态无统计学差异(P>0.05).结论 DECTA在颅内微小动脉瘤(IMA)的检出率与DSA并无统计学差异(P>0.05),加之其无创性,故在临床服务中价值更高,VE显示动脉瘤内壁的膨出部分及破口受软斑和钙斑的影响很大,如果内壁光滑或规则钙斑,可以看到光滑的隆起膨出部分,如果内有纤维斑、脂肪斑及不规则钙斑,则可显示隆起内壁凹凸不平.

Object ve To investigate the value of Dual energy 64-slices （DECTA） in the diagnosis of intracranial micro-aneurysms （IMA）. Methods computed tomography angiography We retrospectively analyzed the clinical history and images of 37 intracranial micro-aneurysms. Patients with IMA were performed both DECTA and DSA. Finally IMA was confirmed by operation and interventional procedures. Results In total of 37 intracranial micro-aneurysms in 33 patients, 34 were detected by DECTA, there was 1 false-positive finding and 4 false-negative findings by DECTA; 36 were detected by 3D-DSA, no false-positive findings and one false-negative finding. With 3D-DSA as the standard, the sensitivity, specificity and accuracy of DECTA for IMA was 91.6%, 100% and 91.9%, respectively. VE showed 22 （including two calcium plaques） with aneurysm bulge and clear wall, and 15 （with 9 soft spots, six of calcium plaque） with aneurysm bulge and rough wall. There was no statistically significant difference in the detection rate of IMA between DECTA and 3D-DSA （P 〉 0.05）. Gonclusions There is no statistically significant difference between DECTA and DSA in the detective rate of IMA, the Clinical value of DECTA is higher because of noninvasive performing. VE shows that soft plaque and calcium spots have a great impaction on the bulging part and crevasse of the aneurysm wall, if the calcium spots is rule and wall is smooth, the smooth bulging part can be seen, if there are fibrous plaques, fatty plaque and irregular calcium spots, uneven wall can be seen.