三维CT血管造影对老年脑动脉瘤及破裂出血诊断价值探讨

Application of 3D-CTA in elderly patients with cerebral aneurysm and its diagnostic value in rupture hemorrhage

目的 探讨三维CT血管造影(3D-CTA)检查技术在老年脑动脉瘤患者中的应用,并分析其对破裂出血的诊断价值。方法 选取2019-06-01-2022-02-01南阳南石医院收治的117例疑似脑动脉瘤老年患者为研究对象,均行3D-CTA检查。以手术病理结果为金标准,分析3D-CTA检查脑动脉瘤的诊断结果及诊断效能,以及3D-CTA检查载瘤动脉与脑动脉瘤瘤颈关系;观察不同破裂出血情况患者3D-CTA检查相关参数[位置、数目、入射夹角、高度、长度、宽度、血栓、子囊形态、瘤体钙化、直径、瘤体长径/瘤颈宽度(AR)]差异。结果 117例疑似脑动脉瘤患者,手术病理共检出阳性82例,阴性35例;3D-CTA检查检出阳性78例,阴性39例;三维数字减影全脑血管造影术(3D-DSA)检查检出阳性81例,阴性36例。3D-CTA检查对脑动脉瘤诊断Kappa指数为0.803,与3D-DSA检查的0.899接近,P>0.05。3D-CTA检查显示脑动脉瘤瘤颈与其载瘤动脉关系为Ⅲ级的占80.77%,与3D-DSA检查的92.59%相比,差异无统计学意义,χ^(2)=6.460,P=0.091。破裂出血与未破裂出血的脑动脉瘤患者,3D-CTA检查入射夹角、长度、宽度、子囊形态、AR相比,差异有统计学意义,均P<0.05。结论 3D-CTA检查对老年脑动脉瘤患者具有较高应用价值,且可为破裂出血的早期诊断提供可靠依据。

Objective To investigate the application of three-dimensional CT angiography(3D-CTA)in elderly patients with cerebral aneurysm and analyze its diagnostic value in rupture hemorrhage.Methods Totally 117elderly patients with suspected cerebral aneurysm in Nanyang Nanshi Hospital from June 1,2019 to February 1,2022 were selected for 3D-CTA examination.Using surgical pathology as the gold standard,the diagnostic results and diagnostic efficacy of 3DCTA in the examination of cerebral aneurysm were observed,and the relationship between the host artery and the cervical tumor of cerebral aneurysm was analyzed.The differences of 3D-CTA examination parameters,including location,number,incident angle,height,length,width,thrombus,ascus morphology,tumor calcification,diameter,and radial neck ratio(AR,tumor length diameter/tumor neck width)of patients with different rupture and bleeding conditions were observed.Results Using surgical pathology as the gold standard,82 cases were positive and 35 cases were negative in 117 suspected cerebral aneurysm patients.Seventy-eight cases were positive and 39 cases were negative diagnosed by 3D-CTA,81 cases were positive and 36 cases were negative diagnosed by three-dimensional digital subtraction angiography(3D-DSA).The Kappa index of 3D-CTA was close to that of 3D-DSA(0.803 us 0.899,P>0.05).3D-CTA examination showed that 80.77%of the patients with cerebral aneurysms had grade II relationship with the host artery,and there was no significant difference between 3D-DSA examination(92.59%)and the cervical tumor(χ^(2)=6.460,P=0.091).The difference of incident angle,length,width,morphology/ascus and AR in 3D-CTA examination between cerebral aneurysm patients with ruptured hemorrhage and those without ruptured hemorrhage was statistically significant(P<0.05).Conclusion 3D-CTA has high value in the detection of elderly patients with cerebral aneurysm,and can provide a reliable basis for the early diagnosis of rupture hemorrhage.