蛛网膜下腔出血CT分布对颅内动脉瘤检出的价值

CT location distribution of subarachnoid hemorrhage and its value in intracranial aneurysm detection

目的通过对比分析不同部位动脉瘤致蛛网膜下腔出血(SAH)的分布差异,探讨其CT分布对提高CTA颅内动脉瘤检出率的价值。方法对2019年1月至2020年10月首都医科大学附属北京天坛医院收治的415例颅内动脉瘤致SAH患者行CT和CTA检查,比较不同部位动脉瘤致SAH的分布差异,对比分析高年资与低年资影像科医师对动脉瘤的检出率。结果共415例患者计463个动脉瘤,包括Ⅰ类动脉瘤324个、Ⅱ类动脉瘤139个;其中责任动脉瘤415个,包括Ⅰ类动脉瘤295个、Ⅱ类动脉瘤120个。Ⅰ类动脉瘤出血主要分布于鞍上池(95.93%,283/295)、环池(90.17%,266/295)、纵裂(86.44%,255/295)、侧裂池(81.02%,239/295)、四叠体池(61.69%,182/295)和桥前池(50.85%,150/295),Ⅱ类动脉瘤出血主要分布于侧裂池(85.83%,103/120)、纵裂(80.83%,97/120)、鞍上池(78.33%,94/120)、环池(77.50%,93/120)、桥前池(67.50%,81/120)和四叠体池(66.67%,80/120);Ⅰ类动脉瘤出血位于鞍上池[95.93%(283/295)对78.33%(94/120);χ^(2)=31.761,P=0.001]和环池[90.17%(266/295)对77.50%(93/120);χ^(2)=11.730,P=0.001]比例高于Ⅱ类动脉瘤,位于桥前池比例低于Ⅱ类动脉瘤[50.85%(150/295)对67.50%(81/120);χ^(2)=9.585,P=0.002)。低年资医师动脉瘤总体检出率(配对χ^(2)检验:P=0.000)和Ⅱ类动脉瘤检出率(配对χ^(2)检验:P=0.000)均低于高年资医师,经培训后Ⅱ类动脉瘤检出率接近高年资医师水平(配对χ^(2)检验:P=0.146)。结论颅内动脉瘤致SAH的CT分布具有规律性,有助于提高CTA颅内动脉瘤检出率。

ObjectiveTo compare the CT location distribution of subarachnoid hemorrhage(SAH)caused by aneurysms at different locations,and to explore the value of CT hemorrhage distribution forimproving the detection of aneurysms in CTA in diagnosing aneurysm.MethodsCerebral CT and CTAimaging of 415 patients with aneurysmal SAH from Beijing Tiantan Hospital,Capital Medical Universityfrom January 2019 to October 2020 were retrospectively analyzed.The differences of SAH locationdistribution caused by the aneurysms were compared,and the accuracy of aneurysm diagnosis betweenjunior and senior radiologists were evaluated.ResultsA total of 415 patients had 463 aneurysms,including 324 type-Ⅰ aneurysms and 139 type-Ⅱ aneurysms.There were 415 responsible aneurysms,including 295 type-Ⅰ aneurysms and 120 type-Ⅱ aneurysms.SAH from type-Ⅰ aneurysms was mainlydistributed in suprasellar cisterna(95.93%,283/295),ambient cistern(90.17%,266/295),longitudinalfissure(86.44%,255/295),sylvian cistern(81.02%,239/295),quadrigeminal cistern(61.69%,182/295) andprepontine cistern(50.85%,150/295).SAH from type-Ⅱ aneurysms was mainly distributed in sylviancistern(85.83%,103/120),longitudinal fissure(80.83%,97/120),suprasellar cisterna(78.33%,94/120),ambient cistern(77.50%,93/120),prepontine cistern(67.50%,81/120) and quadrigeminal cistern(66.67%,80/120).The proportion of hemorrhage in suprasellar cisterna [95.93%(283/295) vs.78.33%(94/120);χ^(2)=31.761,P = 0.001] and ambient cistern [90.17%(266/295) vs.77.50%(93/120);χ^(2)= 11.730,P = 0.001] washigher in type-Ⅰaneurysms than that in type-Ⅱaneurysms,and the proportion of hemorrhage in prepontinecistern was lower in type-Ⅰ aneurysms than that in type-Ⅱ aneurysms [50.85%(150/295) vs.67.50%(81/120);χ^(2)= 9.585,P = 0.002].The overall rate of aneurysms detection and type-Ⅱ aneurysms detection injunior radiologists were lower than those in senior radiologists(paired χ^(2) test:P = 0.000,0.000).After thetraining of SAH distribution,the junior radiologists increased their detection rate of type-Ⅱaneurysms,andshowed no significant difference compared with that of senior radiologists(paired χ^(2) test:P = 0.146).ConclusionsThe CT distribution of aneurysmal SAH has regularity.It’s important to summarize thecharacteristics of SAH for improving the detection of aneurysms.