低管电压CT血管成像与三维旋转血管造影诊断颅内微小动脉瘤的对照研究

Comparative study between low tube voltage cerebral CT angiography and 3D rotational angiography in diagnosis of intracranial micro-aneurysms

目的:探讨100k V低管电压脑CT血管成像(L-CTA)对最大径≤3mm的颅内微小动脉瘤(IMA)的诊断价值。方法:回顾性分析2013年5月至2016年12月在温州医科大学附属第一医院经三维旋转血管造影(3DRA)证实的59例IMA患者的临床和影像资料,L-CTA均采用100k V低管电压检查,与3DRA对照,分析LCTA诊断IMA的敏感性、特异性及准确度,并评价相关辐射剂量。结果:依据3DRA结果,59例患者共有70个动脉瘤,其中65个IMA。L-CTA共检出64个IMA(其中6例多发IMA),误诊3个,漏诊4个。以3DRA作为金标准,采用100k VL-CTA诊断动脉瘤的敏感性、特异性、准确度分别为93.85%、99.56%及99.08%,动脉瘤大小测量结果与3DRA相关性较好。与常规120k V管电压CTA相比,100k V管电压CTA有效剂量降低了35.71%。结论:L-CTA扫描对IMA的诊断敏感性高,且能有效降低辐射剂量。

Objective： To investigate the diagnostic value of low tube voltage cerebral CT angiography （L-CTA） in intracranial micro-aneurysms （IMA, maximum diameter 〈 3 mm）. Methods： The clinical and imaging data of 59 IMA patients confirmed by 3D rotational angiography （3DRA） in the First Affiliated Hospital of Wenzhou Medical University from May 2013 to December 2016 were retrospectively analyzed. All patients had underwent low tube voltage cerebral CT angiography. Comparing with 3DRA, the diagnostic sensitivity, specificity, and accuracy of L-CTA in intracranial micro-aneurysms was evaluated. The related radiation dose in L-CTA was objectively evaluated with the conventional tube voltage. Results： Based on the results of 3DRA, 65 cerebral micro-aneurysms of 70 aneurysms were detected in these 59 cases. CTA detected a total of 64 micro-aneurysms, including multiple micro-aneurysms （n=6）, false positive cases （n=3） and missed cases （n=4）. Comparing with the 3DRA （gold standard）, the diagnostic sensitivity, specificity, and accuracy of L-CTA in IMA were 93.85%, 99.56% and 99.08%, respectively, and the measurement results of aneurysm size were in good correlation with 3DRA. Compared with conventional CTA, the effective dose （ED） of L-CTA reduced by 35.71%. Conclusion： L-CTA has high diagnostic sensitivity in IMA and can effectively reduce the radiation dose.