CTA与MRA在颅内不同部位动脉瘤诊断及破裂出血风险预测的价值研究

Research on the value of CTA and MRA in diagnosing arterial aneurysm and predicting risk of rupture bleeding at intracranial different part

目的:探析颅脑不同部位动脉瘤进行CT血管造影(CTA)与磁共振血管造影(MRA)检查的诊断价值,以及预测不同部位3~5 mm的动脉瘤破裂出血的风险评估。方法:回顾性研究医院收治的128例可疑颅内动脉瘤患者,按照动脉瘤瘤颈与邻近载瘤动脉距离,将其分为3.0~5.0 mm组(96例)和≤3.0 mm组(32例),分别采取3D-CTA及3D-MRA方式进行检查,观察所有研究对象经过不同检查方式的结果。诊断结果以介入或手术结果为“金标准”,比较MRA、CTA及数字减影血管造影(DSA)检查方法用于不同直径颅内动脉瘤的诊断率和准确率。结果:所有患者均为单发肿瘤,3D-CTA检查诊断符合125例(97.7%),3D-MRA诊断符合92例(71.9%),两种检查方法诊断符合率比较,差异有统计学意义(x2=24.78,P<0.05);3D-CTA法检测动脉瘤瘤体颈宽、纵径等指标与3D-MRA检查法比较,差异有统计学意义(t=2.93,t=9.82,P<0.05);3D-MRA与3D-CTA检查在3~5 mm组动脉瘤检出情况比较,差异有统计学意义(x2=34.73,P<0.05),在≤3 mm组动脉瘤两种检查方法间差异有统计学意义(x2=7.50,P<0.05),两种检查方法总体检出结果比较差异有统计学意义(x2=40.68,P<0.05);经手术证实,动脉瘤破裂出血90例,3D-CTA检查法预测动脉瘤破裂出血79例(87.8%),3D-MRA检查法预测动脉瘤破裂出血63例(70.0%),两种检查方式预测动脉瘤破裂出血的准确性比较,差异有统计学意义(x2=8.54,P<0.05)。结论:MRA和CTA检查可用于颅内动脉瘤的诊断和评估其破裂出血的风险,但CTA检查的三维形态和准确性更高。

Objective: To discuss the diagnostic value of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) for arterial aneurysm of intracranial different parts, and predict the risk assessment of rupture bleeding of aneurysm (3-5mm) at different parts. Methods: 128 patients with suspected intracranial aneurysm who were treated in our hospital were retrospectively researched. And all of them were divided into 3.0-5.0mm group (96 cases) and ≤3.0mm group (32 cases) according to the distance between aneurysmal neck and nearby artery that carried aneurysm. And 3D-CTA and 3D-MRA were respectively adopted to implement examination, and the results of different methods for all patients were further observed. The results of intervention or surgery were used as gold standard, and diagnosis rate and accuracy rate of MRA, CTA and DSA for intracranial aneurysms with different diameter were compared. Results: All of the patients were single tumor, and the diagnostic accordance rate of 3D-CTA examination (97.7%, n=125) was significantly higher than that of 3D-MRA (71.9%, n=92)(x2=24.78, P<0.05). And the neck width and vertical diameter of aneurysm between 3D–CTA and 3D-MRA was significantly different (t=2.93, t=9.82, P<0.05). The difference of detectable rate of aneurysm of 3-5mm group between 3D-MRA and 3D-CTA was significant (x2=34.73, P<0.05), and the difference of that of ≤3mm group between the two methods was significant (x2=7.50, P<0.05), and the difference of total detected results between the two methods was significant (x2=40.68, P<0.05). The results of surgery confirmed that rupture bleeding occurred in 90 cases, and the accuracy rate of predicting rupture bleeding of aneurysm of 3D-CTA (n=79, 87.8%) was significantly higher than that of 3D-MRA (N=63, 70.0%)(x2=8.54, P<0.05). Conclusion: Both of MRA and CTA can be applicable to diagnose the intracranial aneurysm and assess the risk of rupture bleeding of aneurysm. However, 3D-CTA has a higher 3D configuration and diagnostic accuracy in clinical practice.