CTPa成像对颅内动静脉分流性疾病的应用价值分析

Application value of CT perfusion-derived arteriograms in cranial arteriovenous shunting lesions

目的:探讨基于320排容积CT灌注检查的动态血管成像(CTPa)对颅内动静脉分流性疾病的临床应用价值。方法:回顾性分析26例经CTPa检查诊断为颅内动静脉分流性疾病患者的影像学资料。以时间为序列进行多时相动态观察,记录病灶的部位、大小及血管构筑特点。其中17例患者行DSA检查,CTPa与DSA结果对照,分析两者诊断一致性。结果:26例患者包括动静脉畸形18例、动静脉瘘8例。CTPa能够明确病灶血管巢及瘘口的特点,显示供血动脉、引流静脉的解剖细节及血流动力学情况。17例患者的CTPa与DSA诊断结果一致,但CTPa漏诊3例动静脉畸形病灶的1根供血动脉(1/21)及3根引流静脉(3/23)。结论 :CTPa能够准确诊断颅内动静脉分流性疾病,并反映其动静脉短路的病理特点,但对于细小结构的显示不及DSA。CTPa对颅内动静脉分流性疾病的诊断具有重要的临床应用价值。

Objective： To explore the clinical application value of CT perfusion-derived arteriograms（CTPa） in cranial arteriovenous shunting lesions. Methods： Twenty-six cases, diagnosed of cranial arteriovenous shunting lesions by CTPa were included in this retrospective study. The location, size and angioarchitecture of the lesions were analyzed from the CTPa images. Using DSA images as the gold standard, the diagnostic and following-up accuracy of CTPa were evaluated in 17 cases. Results： There were 18 arteriovenous malformation cases and 8 arteriovenous fistula cases. CTPa could clearly show the angioarchitecture details of the lesions, including location, feeding arteries, draining veins and dynamic blood flow information. The diagnostic results of CTPa in 17 cases were consistent with those of DSA, but CTPa missed 1（1/21） feeding artery and 3（3/23） draining veins in three cases. Conclusion： Although some fine angioarchitectural details were missed when compared to DSA, CTPa was sufficiently accurate to diagnose the shunt. CTPa can be a valuable adjunct in the diagnosis of cranial arteriovenous shunting lesions.