血管检查在自发性脑内出血或脑室出血病因诊断中的应用价值

Value of vascular examination in diagnosis of spontaneous intracerebral hemorrhage or ventricular hemorrhage

目的探讨血管检查在自发性脑内出血或脑室出血的病因诊断中的应用价值。方法回顾性分析2018年7月至2019年7月救治的100例自发性脑内出血或脑室出血的临床资料,其中脑内血肿56例,单纯脑室内积血19例,脑内出血破入脑室25例,接受320-CTA或DSA检查,查找出血原因。结果320-CTA检查40例,检出动脉瘤5例(出血责任动脉瘤1例,非责任动脉瘤4例),动静脉畸形3例,烟雾病5例,阴性27例;DSA检查73例(其中13例320-CTA阳性),检出动脉瘤7例(出血责任动脉瘤2例,非责任动脉瘤5例),烟雾病9例,动静脉畸形7例,静脉窦血栓2例,硬脑膜动静脉瘘1例,阴性47例。13例同时进行DSA和320-CTA检查,以DSA为诊断“金标准”,320-CTA检查阳性11例,假阳性2例。320-CTA检查时间5~10 min,三维重建时间10~15 min,然后进行诊断并得出结果需1~8 h。DSA检查时间在1 h左右,做完即可得出诊断结果。结论对于自发性脑内出血或脑室出血,建议加强血管检查,提高病因诊断准确度;相比320-CTA,DSA的准确度更高,诊断耗时更短,是脑血管病检查的“金标准”。

Objective To explore the value of vascular examination in the diagnosis of spontaneous intracerebral hemorrhage or ventricular hemorrhage.Methods The clinical data of 100 patients with spontaneous intracerebral hemorrhage or ventricular hemorrhage who were admitted to our hospital from July 2018 to July 2019 were retrospectively analyzed.Of these 100 patients,56 patients had intracerebral hematoma,19 had simple intraventricular hemorrhage and 25 had intracerebral hemorrhage with ventricular extension.The 320-CTA or DSA were performed successively to find out the cause of hemorrhage.Results According to the 320-CTA performed on 40 patients,aneurysms were detected in 5 patients,arteriovenous malformations in 3,moyamoya disease in 5,and negative results in 27.According to the DSA performed on 73 patients,aneurysms were detected in 7,moyamoya disease in 9,arteriovenous malformations in 7,venous sinus thrombosis in 2,dural arteriovenous fistula in 1 and negative results in 47.Of 13 patients underwent both DSA and 320-CTA examinations,11 patients were positive and 2 were false positive according to the 320-CTA when the DSA was the gold standard for diagnosis.The time of 320-CTA examination ranged from 5 to 10 minutes,the time of its three-dimensional reconstruction ranged from 10 to 15 minutes,and then it nend 1~8 hours to obtain the diagnostic results.The time of DSA examination was about 1 hour,and the diagnostic results could be obtained immediately after finishing the examination.Conclusions For spontaneous intracerebral hemorrhage or ventricular hemorrhage,it is recommended to strengthen vascular examination to improve the accuracy of etiological diagnosis.DSA,which is the gold standard for the diagnosis of cerebrovascular disease,has higher accuracy and shorter diagnosis time compared with 320-CTA.