数字减影CTA对蛛网膜下腔出血中动脉瘤的诊断价值

Role of digital subtraction CT angiography in determining aneurysms in subarachnoid hemorrhage

目的:以三维数字减影血管造影(three-dimensional rotational digital subtraction angiography,3D-DSA)和(或)手术结果为金标准,评价数字减影CT血管造影(computed tomographic angiography,CTA)对自发性蛛网膜下腔出血(subarachnoid hemorrhage,SAH)中动脉瘤的诊断价值。方法:回顾性分析56例因自发性SAH而行数字减影CTA检查的影像资料,评估图像质量,确定并记录动脉瘤的有无、数量、位置、大小等,以3D-DSA和(或)手术结果为参考标准,计算数字减影CTA对颅内动脉瘤诊断的敏感性与特异性,对比数字减影CTA与常规CTA对动脉瘤的显示效果。结果:11例患者没有检出动脉瘤,另外45例患者共发现57个动脉瘤。以患者例数为单位,数字减影CTA对SAH中动脉瘤诊断的敏感性与特异性均为100%;以动脉瘤个数为单位,诊断的敏感性与特异性分别为96.49%、100%,漏诊的动脉瘤均为隐匿性、非破裂的微小动脉瘤。数字减影CTA对SAH中动脉瘤的显示效果优于常规CTA(P均<0.05)。结论:数字减影CTA对自发性SAH中动脉瘤具有较高的检出率,可作为首选的影像检查方法。

Objective：To evaluate the value of digital subtraction computed tomographic angiography（CTA）in the detection of intracranial aneurysms in subarachnoid hemorrhage（SAH）by taking three-dimensional rotational digital subtraction angiography（3D-DSA）and（or）surgical findings as reference standard. Methods：The digital subtraction CTA imaging data of 56 patients with SAH were retrospectively collected and reviewed for image quality,and were evaluated for the presence or absence of an aneurysm and the number,location,size of the aneurysms. The sensitivity,specificity of digital subtraction CTA in depicting aneurysms in SAH were analyzed,with 3D-DSA or intraoperative findings or both being used as the gold standards. The diagnostic effects of digital subtraction CTA and conventional CTA on aneurysms were compared. Results：No aneurysm was revealed in 11 patients and 57 aneurysms were revealed in 45 patients. The sensitivity,specificity of digital subtraction CTA for aneurysms in SAH calculated were 100% and 100%per patient,96.49% and 100% per aneurysm. All missed diagnosed aneurysms were un-ruptured small occult aneurysms in patients harboring multiple aneurysms. The digital subtraction CTA was superior to conventional CTA in diagnosing aneurysms. Conclusion：The digital subtraction CTA is excellent in detecting intracranial aneurysms in SAH. It can be used as the primary imaging method.