三维数字减影血管造影与三维64层螺旋血管造影在颅内动脉瘤检查中的对比研究

Comparison study on 3D-DSA and 3D-64-multislice CTA contrast research in inspection of intracranial aneurysms

目的对比研究三维64层螺旋CT血管造影（3D-CTA）和三维数字减影血管造影（3D-DSA）诊断颅内动脉瘤（AN）（尤其是直径〈3mm的微小AN）的价值,以及3D-CTA与3D-DSA不同技术之间的对颅内AN检出率的一致性分析.方法共有61例患者纳入本研究,其中女性23例,男性38例,平均年龄51岁;所有患者磁共振血管造影或临床表现提示颅内动脉瘤.所有患者行3D-DSA和3D-CTA.以3D-DSA为“金标准”,评估3D-CTA诊断颅内动脉瘤的准确性、特异性、灵敏度以及不同技术间的一致性.结果3D-DSA在53例患者中共检出61个AN病灶,其余8例未发现AN.3D-CTA检出AN52个,准确性为92.9% ～95.6%（均值93.8%）,灵敏度为92.9% ～93.9%（均值93.2%）,特异性为82.9% ～100.0%（均值91.2%）;对于AN病灶直径〈3mm,3D-CTA的灵敏度和特异性均值分别为85.5%和94.0%.对AN的检出,3D-CTA判读者之间及3D-CTA与3D-DSA不同技术之间一致性均为优-良（K=0.786～0.859,均值K=0.789）;对于AN瘤体最大径的测量,3D-CTA判读者之间及3D-CTA与3D-DSA间差异均无统计学意义（P〉0.05）.结论3D-64层螺旋CTA对AN灵敏度和特异性较高,与3D-DSA之间的一致性较高,可以作为疑似AN患者的首选筛查方法.两者联合可提高AN的检出率,为介入治疗AN提供可靠的影像学依据.

Objective To compare digital subtraction angiography(DSA)and three-dimensional rotational angiography(3D-DSA) with 64-multislice 3D-CT angiography(CTA)in the detection and characterization of intracranial aneurysms(especially diameter <3 mm), and assess inter- technique and inter-observer reproducibility of 64 -multislice 3D-CTA for detection and evaluation of intracranial aneu-rysms. Methods From September 2011 to March 2013,a total of 56 consecutive patients with suspected aneurysm were enrolled,included 31 males and 25 females,who with a mean age of 51. All of the patients underwent both 3D-CTA and 3D-DSA. Two radiologists independently re-viewed CT images,and 2 other radiologists reviewed 3D-DSA images. Using 3D-DSA as the″gold standard″,the sensitivity,specificity,inter-technique and inter-observer reproducibility of 3D-CTA were assessed. Results The 3D-DSA revealed 61 aneurysms in 53 patients and non- aneurysm in 9. The 3D-CTA revealed 52 aneurysms,accuracy,mean sensitivity and specificity of 3D-CTA for the detection of intracra-nial aneurysms were 93. 8%(92. 9% ~95. 6%),93. 2%(92. 9% ~93. 9%)and 91. 2%(82. 9% ~100. 0%),respectively. For aneurysms <3 mm,CTA had the mean sensitivity of 85. 5% and specificity of 94. 0%. Inter -technique and inter -observer agreements were excellent for detection of aneurysms(K=0. 786~859 and K=0. 789,respectively). For the measurement of aneurysm diameters,the results showed no statis-tically significant difference( P >0. 05). Conclusion It is demonstrated that the 3D 64-multislice CTA is an imaging method with good inter-observer reproducibility and high sensitivity and specificity for the detection and morphologic evaluation of ruptured intracranial aneurysms( es-pecially diameter <3 mm). Combination of the 2 methods could improve the detection rate of aneurysm,and provide the reliable interventional ra-diological basis for aneurysm.