3D-CTA与3D-DSA对颅内动脉瘤评价的对比研究

Comparative study in evaluations of intracranial aneurysms between 3D-CTA and 3D-DSA

目的:探讨256层三维螺旋CT血管造影(3D-CTA)与三维数字减影血管造影成像(3D-DSA)技术对颅内动脉瘤(LAN)诊断的成像对比,并评价256层3D-CTA对LAN的诊断及其临床价值。方法:选取医院收治的80例在神经外科诊断疑似为LAN且均接受3D-CTA和3D-DSA检查的患者。以3D-DSA技术检查作为参考标准,来评价3D-CTA技术对发现LAN的敏感性、特异性、准确性、阳性预测值和阴性预测值,并比较3D-CTA与3D-DSA在动脉瘤的检出率上的差异。结果:3D-CTA与3D-DSA在LAN检出率方面比较,差异无统计学意义。根据3D-DSA检查结果以及术中所见情况,80例患者中共有68例最终确诊为LAN85个。其中单发动脉瘤46例,多发动脉瘤22例。动脉瘤直径为1.2~21.5 mm,平均直径为7.8 mm;<3 mm的动脉瘤23个(占27.1%),3~5 mm的动脉瘤38个(占44.7%),5~10 mm的动脉瘤18个(占21.2%),10~25mm的动脉瘤6个(占7.1%)。3D-CTA技术准确检出动脉瘤78个,漏诊动脉瘤7个(平均直径为2.8mm);CTA诊断准确率为91.8%,灵敏度为88.6%~92.3%,特异度为90.7%~100%,阳性预测值为96.7%,阴性预测值为77.3%。动脉瘤CTA诊断的灵敏度<3 mm、3~5 mm和>5 mm分别为88.6%、92.3%和100%。结论:3D-CTA可以替代3D-DSA进行LAN术前的诊断以及术后的复查,检出率及准确性较高。

Objective:To explore the comparison of imaging difference between256-slice three-dimensional spiral CT angiography(3D-CTA)and three dimensional-digital subtraction angiography(3D-DSA)for diagnosis of intracranial aneurysms.And to evaluate the diagnosis and clinical value of256-slice three-dimensional spiral CT angiography for intracranial aneurysms.Methods:80suspected patients with intracranial aneurysms diagnosed by neurosurgery have received detections of3D-CTA and3D-DSA.3D-DSA was chosen as the reference standard to evaluate the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of3D-CTA for finding intracranial aneurysms,and to compare the differences of detection rate for aneurysms between3D-CTA and3D-DSA.Results:The difference of detection rate between3D-CTA and3D-DSA was no statistical significance.According to examination results of3D-DSA and intraoperative situation,85intracranial aneurysms were found in68confirmed cases of80patients,and in the68cases,46cases were single aneurysm and22cases were multiple aneurysms.The diameter range of aneurysm was1.2-21.5,and the average diameter was7.8mm.In these aneurysms,the diameter of23aneurysms was less than3mm(27.1%of the total),the diameter range of38aneurysms was between3-5mm(44.7%of the total),the diameter range of18aneurysms was between5-10mm(21.2%of the total),and the diameter range of6aneurysms was between10-25mm(7.1%of the total).78aneurysms were correctly detected by3D-CTA,and7aneurysms(average diameter was2.8mm)were missed diagnosis.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of3D-CTAwas91.8%,88.6%~92.3%,90.7%~100/%,96.7%and77.3%,respectively.When the diameter of aneurysms range were less than3mm,between3-5mm and larger than5mm,the sensitivities of CTA were88.6%,92.3%and100%,respectively.Conclusion:3D-CTA can supersede3D-DSA for detecting intracranial aneurysm in preoperative diagnosis and postoperative reexamination,and it has higher detection rate and accuracy.