双能量CT血管成像技术诊断颅内硬脑膜动静脉瘘（附六例报告）

Diagnosis and evaluation of dural arteriovenous fistula with dual energy CT： a report of 6 cases

目的探讨双源CT双能量成像技术在颅内硬脑膜动静脉瘘（DAVF）诊断中的临床应用价值。方法广州军区广州总医院放射科自2009年1月至2013年1月采用西门子双源CT、头颈部血管疾病的双能量成像技术成功诊断颅内DAVF患者6例，并全部行全脑血管造影（DSA）证实．回顾性分析其影像学资料。结果颅脑双能量CT血管造影（DECTA）检查发现6例DAVF中所有患者增粗的供血动脉、扩张的引流静脉及硬膜窦可清晰显示，所有患者引流到脑表或颅内静脉形成静脉网，并行全脑血管造影（OSA）证实，DECTA和DSA两者之间符合率100％。头颅CT显示蛛网膜下腔出血3例，脑内血肿2例。结论DECTA能较好地显示因DAVF所致的颅内继发性病变、异常增粗的供血动脉及扩张的引流静脉、硬膜窦及颅骨的三维立体结构，并可任意角度重建图像，与全脑DSA有很好的符合率，一定程度上可以替代它。可作为疑有DAVF的患者介入栓塞治疗和手术切除前非创伤性筛查的新选择。

Objective To explore the clinical application value of dual-energy imaging with dual-source CT in dural arteriovenous fistula （DAVF）. Methods Six patients diagnosed as having DAVF by dual-energy angiography with dual-source CT （DECTA）, conformed by DSA in our hospital fTom January 2009 to January 2013, were chosen in our study; their imaging data were retrospectively analyzed. Results The enlarged feeding arteries, dilated draining veins and dural venous sinus of the DAVF in all patients were clearly demonstrated on DECTA. The draining veins of all six patients routed into the intracranial vein with forming venous collaterals. The imaging results were concordant exactly with their results of DSA （100%）. The other changes of DAVF by cranial CT were subarachnoid hemorrhage in 3 cases and brain hemorrhage in 2 cases. Conclusion DECTA can demonstrate distinctly the secondary changes, feeding arteries, draining veins, dural venous sinus, and the skull three dimensional structure of DAVF; the imaging results were concordant exactly with their results of DSA, and can replace it in a way, as a new non-traumatic screening choice for suspected DAVF patients before embolization therapy and surgical resection.