CT血管成像与数字减影血管造影对颅内动脉瘤的临床应用价值

Significance of computed tomography angiography versus digital subtraction angiography in intracranial aneurysm

目的探讨CT血管成像(CTA)与数字减影血管造影(DSA)对颅内动脉瘤的临床应用价值。方法选取2013年5月至2016年5月间沈阳市第二中医医院收治的118例颅内动脉瘤患者,均先行CTA检查,后行DSA检查。比较CTA和DSA对颅内动脉瘤的检出率、灵敏度、准确度及空间关系显示的差异。结果 CTA检查共发现动脉瘤123个,多发11例,假阳性3例。DSA检查共发现动脉瘤122个,多发10例,假阳性2例,两种方法检出的动脉瘤数目比较,差异无统计学意义(P>0.05)。两者所测瘤体直径及瘤颈宽度比较,差异均无统计学意义(均P>0.05)。两者造影图像比较,CTA可通过最大密度投影和三维技术,显示颅内动脉血管瘤大小及形态,瘤颈与载瘤动脉的关系较DSA更清晰,DSA显示细小动静脉及血流方向优于CTA。结论 CTA与DSA诊断颅内动脉瘤,效果相近,CTA易操作且无创,可成为原发性蛛网膜下腔出血的首要诊断根据。

Objective To explore the significance of clinical values of computed tomography angiography（ CTA） and digital subtraction angiography（ DSA） in intracranial aneurysm. Methods A total of118 patients with intracranial aneurysm admitted to Shenyang Second Traditional Chinese Medicine Hospital from May 2013 to May 2016 were selected. All the patients underwent CTA followed by DSA examinations.Difference in detection rate,sensitivity,accuracy and spatial relationships were compared between CTA and DSA for intracranial aneurysm. Results DSA is considered as the diagnostic gold standard. Generally,CTA found 123 aneurysm,and 11 were multiple and 3 were false positives. DSA found aneurysm 122 aneurysm,and 10 were multiple and 2 were false positive. No statistically significant difference was found in the number of aneurysm detected between the two method（ P〈0. 05）. There was no statistically significant difference in the tumor diameter and neck width measured between the two method（ P〈0. 05）. When comparing the angiographic image,CTA could display the size and configuration of intracranial aneurysm by maximum intensity projection and three-dimensional visualization technology and the relationship between the aneurysmal neck and parent arteries was clearer in CTA than DSA. However,DSA was superior to CTA in displaying some fine veins and arteries and blood flow. Conclusion The ability of CTA and DSA in the diagnosis of aneurysm is similar. CTA was easy to operate and was noninvasive and could be used as the primary diagnosis mode of primary subarachnoid hemorrhage.