容积CT数字减影血管造影与匹配蒙片去骨法对颅内动静脉畸形诊断价值的比较

Diagnostic value of volume CT digital subtraction angiography versus matched mask bone elimination for intracranial arteriovenous malformation:a comparative analysis

目的:比较容积CT数字减影血管造影(volume CT digital subtraction angiography,VCTDSA)与匹配蒙片去骨(matched mask bone elimination,MMBE)对颅内动静脉畸形的诊断价值。方法:回顾性分析2015年2月至2018年2月于我院行头部或头颈CTA检查并经DSA或手术确诊为颅内动静脉畸形的37例患者临床及影像学资料。由同一操作者使用VCTDSA法与MMBE法对CTA原始图像进行重建处理,评价病灶畸形血管团、供血动脉和引流静脉以及自动、手动减影后整体图像质量等级,并比较两者后处理时间。结果:2种技术的自动、手动及总体减影时间均具有统计学差异(P=0.000),VCTDSA法自动减影时间短于MMBE法,而手动减影时间及总体减影时间长于MMBE法。37例颅内动静脉畸形患者图像质量比较,自动减影图像质量MMBE法Ⅱ级者更多(59.5%,22/37),VCTDSA法Ⅲ级者更多(62.2%,23/37),两者差异有统计学意义(P=0.000);手动减影图像质量VCTDSA法Ⅰ级者更多(56.8%,21/37),MMBE法Ⅱ级者更多(62.2%,23/37),差异有统计学意义(P=0.011)。19例位于浅表脑实质的动静脉畸形中,VCTDSA法对引流静脉显示优于MMBE法(P=0.035),两者差异具有统计学意义。VCTDSA法与MMBE法对37例患者畸形血管团、供血动脉显示差异无明显统计学意义(P=0.317,P=0.739)。结论:VCTDSA显示位于浅表脑实质的动静脉畸形效果较好,尤其是对引流静脉的显示明显优于MMBE,而MMBE去骨更彻底,自动减影图像质量优于VCTDSA,减影后处理时间更短。

Objective:To compare the diagnostic value of volume CT digital subtraction angiography(VCTDSA)and matched mask bone elimination(MMBE)for intracranial arteriovenous malformation(AVM). Methods:A retrospective analysis was performed on the clinical and imaging data of 37 patients who underwent head or head-and-neck computed tomographic angiography(CTA)and was diagnosed with intracranial AVM by digital subtraction angiography(DSA)from February 2015 to February 2018 in our hospital. The original images were reconstructed by the same operator using VCTDSA and MMBE. The image quality of malformed vessels,feeding arteries,and draining veins,and their automatic subtraction image and manual subtraction image were evaluated,and the post-processing time was compared. Results:There was a significant difference in the automatic,manual,and total subtraction time between VCTDSA and MMBE(P=0.000). VCTDSA had a shorter time of automatic subtraction than MMBE,but a longer time of manual and total subtraction than MMBE. In 37 patients with intracranial AVM,the image quality of automatic subtraction was mainly classified as grade Ⅱ by MMBE(59.5%,22/37)and grade Ⅲ by VCTDSA(62.2%,23/37);there was a significant difference between the two methods. The image quality of manual subtraction was mainly classified as grade Ⅰ by VCTDSA(56.8%,21/37)and grade Ⅱ by MMBE(62.2%,23/37);there was a significant difference between the two methods(P=0.011). In 19 patients with AVM located in the superficial brain parenchyma,VCTDSA had significantly better image quality of the draining veins than MMBE(P=0.035).There was no significant difference in the image quality of malformed vessels and feeding arteries of all the 37 patients between VCTDSA and MMBE(P=0.317 and 0.739). Conclusion:VCTDSA has better image quality than MMBE for the AVM located in superficial brain parenchyma,especially the draining veins. However,MMBE subtracts the bone thoroughly,has better image quality of automatic subtraction,and can save more time in post-processing.