4D-CTA在颅内动静脉畸形诊断中的应用价值

The application value of 4D-CTA in the diagnosis of intracranial arteriovenous malformations

目的:探究四维CT血管造影(4D-CTA)在颅内动静脉畸形(AVM)诊断中的应用价值。方法:回顾性收集本院在2017年1月至2022年5月诊断为颅内AVM患者60例,采用4D-CTA扫描方案的30例患者作为4D-CTA组,采用常规三维CT血管造影(3D-CTA)扫描方案的30例患者作为3D-CTA组,两组分别与对应数字减影血管造影(DSA)比较AVM的位置、最大直径、供血动脉数目、引流静脉的数量及Spetzler&Martin(SM)分级评分,并进行两组间图像质量及辐射有效剂量对比。结果:4D-CTA组辐射有效剂量比3D-CTA组稍高,但两组结果分别与对应的DSA诊断对比,判断位置完全一致、最大直径差异无统计学意义(P>0.05);4D-CTA组在诊断供血动脉的灵敏度及特异度分别为92.3%、100%,引流静脉的灵敏度及特异度均为100%;3D-CTA组在诊断供血动脉灵敏度及特异度为84.9%、99.2%,引流静脉两组灵敏度与特异度分别为93.9%、96.3%;SM分级评分中,4D-CTA组与DSA诊断一致,3D-CTA组有3例DSA诊断2级的患者被评分到3级,3D-CTA组及4D-CTA组两组数据的伪影指数(AI)及对比噪声比(CNR)之间比较在基底动脉、左侧颈内动脉、左侧颈外动脉、大脑后动脉、右侧大脑中动脉的差异有统计学意义(P<0.05)。结论:4D-CTA可以动态多角度观察AVM形态,区分主要供血动脉的能力与DSA相似,在识别更小和特定的动脉分支方面比3D-CTA更精确,4D-CTA对颅内AVM的诊断具有重要的临床意义。

Objective:To investigate the application value of four-dimensional CT angiography(4D-CTA)in intracranial arteriovenous malformation(AVM)diagnosis.Methods:The number of 60 cases of AVM patients in The First Affiliated Hospital of Sun Yat-sen University from January 2017 to May 2022 were retrospectively analyzed,one group(30 patients)underwent 4D-CTA scan and another group underwent 3D-CTA scan.Characteristics of AVM,including location,maxim diameter,feeding artery numbers,drainage venous numbers,SM grading scores were compared respectively to DSA.The radiational effective dose and the image quality between the two groups were also compared.Results:Compared with DSA,two groups had identical diagnostic effect in AVM location and no significant difference in maxim diameter.The sensitivity and specificity of the 4D-CTA group in diagnosing the feeding artery were 92.3%and 100%,respectively,and the sensitivity and specificity of diagnosing the draining vein were both 100%,while the sensitivity and specificity of the 3D-CTA group in diagnosing the feeding artery were 84.9%and 99.2%,the sensitivity and specificity of the two groups of draining veins were 93.9%and 96.3%,respectively.In SM grading scores,4D-CTA group has similar efficiency with the DSA,while 3D-CTA group misclassified three 2nd grade cases to the 3rd grade.The differences in AI and CNR between the 3D-CTA group and 4D-CTA group were statistically significant in the basilar artery,left internal carotid artery,left external carotid artery,posterior cerebral artery,and right middle cerebral artery(P<0.05).Conclusion:4D-CTA provides more dimension to analyze AVM morphology characteristics.With same ability to discriminate feeding artery numbers,4D-CTA is more accurate in finding smaller and specific arterial branches than 3D-CTA.Therefore,4D-CTA has important clinical significance for the diagnosis of intracranial AVM.