Myocardial bridging analysis by coronary computed tomographic angiography in a Saudi population

AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography(CCTA). METHODS: A total of 350 CCTA of Saudi patients were included in this study(236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications(typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association. RESULTS: Myocardial bridging was found in 89 of 350(22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending(LAD)(24.6%), followed by distal LAD(3.7%), diagonal branches(2%), ramus intermedius artery(1.4%) and obtuse marginal artery(0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females(P = 0.14). Coronary artery atherosclerosis was found in 51 of 89(57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35(94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries. CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study.

Feasibility of Subtraction Coronary Computed Tomographic Angiography and Influencing Factor Analysis: a Retrospective Study

Objective To investigate the feasibility of subtraction coronary computed tomographic(CT)angiography(SubCCTA)to decline calcium artifacts and improve diagnostic accuracy in the presence of coronary calcification and analyze the factors that influence SubCCTA.Methods A total of 294 patients suspected of having coronary artery diseases underwent coronary computed tomographic angiography(CCTA)and SubCCTA.Coronary stenoses were blindly evaluated by two experienced radiologists,which were compared with invasive coronary angiography(ICA).Multiple statistical indexes were adopted to analyze the value of SubCCTA for the diagnosis of calcium stenoses.Results The diagnosable rate of SubCCTA was 67.2%(n=197),and the non-diagnosable rate was 32.8%(n=97).Using SubCCTA,the false positive rate decreased from 56.5%to 17.4%,and the corresponding diagnostic accuracy was increased from 83.6%to 92.9%.Univariate logistic regression analysis showed that height(OR=1.029,95%CI=1.001–1.058),weight(OR=1.025,95%CI=1.004–1.046),left ventricular size(OR=1.018,95%CI=1.007–1.030),cardiothoracic ratio(OR=39.917,95%CI=1.244–1281.098),the average heart rate(OR=0.866,95%CI=0.836–0.896)and heart rate range(OR=0.882,95%CI=0.853–0.912)might be the factors influencing SubCCTA.Conclusion This study suggested that SubCCTA could help improve diagnostic accuracy in the presence of calcium plaques.Moreover,several factors were discovered for the first time to possibly influence SubCCTA,which will be helpful in improving the subtracted image quality.

Incremental value of preprocedural coronary computed tomographic angiography to classical coronary angiography for prediction of PCI complexity in left main stenosis

Introduction: The aim of our study was to assess the incremental value of Coronary Computed Tomography Angiography (CCTA) added to classical coronary angiography, for complex characterization of coronary lesions and prediction of procedural complexity in patients with significant left main (LM) stenoses. Material and Methods: Thirty-six patients with LM disease were enrolled in the study, and each subject underwent CCTA followed by coronary angiography and percutaneous revascularization. Results: Logistic regression analysis indicated a good correlation between the angiographic-calculated and the CCTA-derived Syntax scores for the whole group (r = 0.87, p < 0.0001) and for the high risk subgroup (r = 0.86, p < 0.0001), but not for the low and intermediate risk (r = 0.38, p = 0.21 and r = 0.62, p = 0.07 respectively). In cases which required complex PCI procedures, both angiographic and CCTA Syntax score were significantly higher than those who did not require complex revascularization procedures (24.5 +/-11.5 vs 32.2 +/-14.6, p = 0.09 for Angio Syntax, 35.3 +/-11.5 vs 25.2 +/-11.3, p = 0.01 for CCTA). In the same time, Ca scoring was significantly higher and plaque volumes were significantly larger in cases requiring complex revascularization procedures (299.5 +/-359.6 vs 917.3 +/-495.4, p = 0.04 for calcium score, 79.7 +/-28.5 vs 108.7 +/-25.3 mm3, p = 0.002 for plaque volumes). Multivariate analysis identified the following CCTA parameters as significant predictors of increased risk for complex intervention in LM lesions: plaque volume (OR 8.00, p = 0.008), Ca scoring (OR 6.37, p = 0.02) and CCTA Syntax score (OR 6.87, p = 0.01). Conclusions: CCTA derived parameters provide incremental information to classical coronary angiography for preoperative assessment of lesion severity in complex left main stenosis. CCTA derived Syntax score significantly correlates with the classical Coronary Angiography Syntax score and identifies the subgroup of patients who will be more exposed to procedural complications during the revascularization interventions.

The value of three-dimensional computed tomographic angiography in the early diagnosis and treatment of spontaneous subarachnoid hemorrhage (616 cases report)

Objective To evaluate the clinical value of three dimensional computerized tomography angiography in the diagnosis and treatment of spontaneous subarachnoid hemorrhage. Methods 616 cases were diagnosed as suspected intracranial aneurysms in 3D CTA system. Computed tomographic scans and CTA studies were

Splanchnic vein thrombosis in necrotizing acute pancreatitis: Detection by computed tomographic venography

AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography(DSA)within 3 d were analyzed in this retrospective comparative study.All CTV procedures were performed with a dual-source CT scanner.The presence and location of SVT were determined via blinded imaging data analyses.RESULTS:According to the DSA results,17(39.5%)of the total 43 patients had SVT.The sensitivity,specificity,positive and negative predictive values of CTV for SVT detection were 100%(95%CI:77.1%-100%),92.3%(95%CI:73.4%-98.7%),89.5%(95%CI:65.5%-98.2%)and 100%(95%CI:82.8%-100%),respectively.CONCLUSION:CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.

Numerical Simulation of Flow Behavior in Basilar Bifurcation Aneurysms Based on 4-Dimensional Computed Tomography Angiography

Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furthermore, fluid-structure interactions have been recently applied for simulation of an elastic cerebral aneurysm model. Herein, we examined cerebral aneurysm hemodynamics in a realistic moving boundary deformation model based on 4-dimensional computed tomographic angiography (4D-CTA) obtained by high time-resolution using numerical simulation. The aneurysm of the realistic moving deformation model based on 4D-CTA at each phase was constructed. The effect of small wall deformation on hemodynamic characteristics might be interested. So, four hemodynamic factors (wall shear stress, wall shear stress divergence, oscillatory shear index and residual residence time) were determined from the numerical simulation, and their behaviors were assessed in the basilar bifurcation aneurysm.

Noninvasive three-dimensional computed tomographic angiography in preoperative detection of intracranial arteriovenous malformations

Obejctive To assess the value of noninvasive three dimensional computed tomographic angiography (3D CTA) in preoperative detection of intracranial arteriovenous malformations (AVMs) Methods A prospective evaluation at a single institute over a 2 year period included 23 patients suspected of intracranial AVMs All patients underwent 3D CTA and digital subtraction angiography (DSA) Results from both procedures were compared Results 3D CTA imaging provided excellent visualization of intracranial AVMs The false positive error and false negative error were zero in our sample The details of arterial supply (numerical measure, orientation, caliber and routing) and vascular nidus (size, morphosis and location) provided by 3D CTA images were the same as DSA and the details of venous drainage were an approximate match Additionally, 3D CTA can depict tridimensional anatomical information for AVMs and their relationship to adjacent structures, a function not possible with DSA This assisted the surgeons in making better surgical planning and reduced trauma As a non invasive course, there were no related complications in the course of 3D CTA processing Conclusions DSA is still regarded as the gold standard for intracranial AVMs detection The modality of 3D CTA is accurate, noninvasive, nearly risk free and low price; we could routinely use it instead of or as a supplement to DSA, in the preoperative detection of suspected intracranial AVMs and postoperative radiological follow up 3D CTA adds tridimensional aspect and assists the surgeon in a the more accurate therapeutic scheme Preliminary data suggest that 3D CTA is playing a favorable role in the assessment of patients with intracranial AVMs

Impact of Clinical Guideline Recommendations on the Application of Coronary Computed Tomographic Angiography in Patients with Suspected Stable Coronary Artery Disease

Background： Coronary computed tomographic angiography （CCTA） has been widely used in patients who are at intemaediate risk for having stable coronary artery disease （SCAD）, and 2013 European Society of Cardiology Guidelines on the Management of SCAD （2013G） recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice. Methods： A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model （UDFM）. Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA. Results： Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time （P = 0.8701）. The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before （22.29%） or after （19.98%） the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G （odds ratio, 1.002; 95% confidence interval, 0.982-1.021; P = 0.8678）. Conclusions： These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.

Coronary Computed Tomographic Angiography for Suspected Stable Coronary Artery Disease： Gap Between the 2013 European Society of Cardiology Guideline Recommendations and Clinical Practice

Coronary computed tomographic angiography （CCTA） as a noninvasive diagnostic technique for the evaluation of coronary anatomy is widely used clinically. Its advantages include high sensitivity and specificity for the diagnosis of present of coronary artery lesions and lesion characteristics,

Understanding the predictive value and methods of risk assessment based on coronary computed tomographic angiography in populations with coronary artery disease:a review

Risk assessment in coronary artery disease plays an essential role in the early identification of high-risk patients.However,conventional invasive imaging procedures all require long intraprocedural times and high costs.The rapid development of coronary computed tomographic angiography(CCTA)and related image processing technology has facilitated the formulation of noninvasive approaches to perform comprehensive evaluations.Evidence has shown that CCTA has outstanding performance in identifying the degree of stenosis,plaque features,and functional reserve.Moreover,advancements in radiomics and machine learning allowmore comprehensive interpretations of CCTA images.This paper reviews conventional as well as novel diagnostic and risk assessment tools based on CCTA.

Intracranial aneurysm with neck indistinguishable from surrounding artery branches by cerebral angiography

The aim of this study is to examine morphology of intracranial aneurysm with neck indistinguishable from surrounding artery branches by cerebral angiography and discuss whether such aneurysms can be treated by interventional embolization. 6 patients who had not been treated by embolization due to irregular wide-necked aneurysms indistinguishable from surrounding artery branches by cerebral angiography received craniotomy for aneurysm clipping. The operations succeeded. Morphologically, neck width and location of the aneurysms were carefully observed and photographed from different directions and multi-angles during operation. The intraoperative findings were compared with the preoperative CTA and DSA images. Walls of the 6 patients’ aneurysms tightly clung to or adhered to surrounding branches and oppressed the branches into arcs, similar to the aneurysm walls in shape, and arterial branches and aneurysm walls suffered from segmental adhesion. In addition, abnormalities of communicating arteries to vary degrees were observed in 4 patients. However, after successful surgical clipping, it was revealed that the aneurysms would have been better treated by embolization since they are basically saccular aneurysms with regular sizes. Deformations in preoperative angiography may be due to anatomical variations of surrounding vessels near the aneurysms, aneurysm wall oppression or incomplete adhesion of surrounding arterial branches. Such deformations can be recognized by careful observation in preoperative angiography from different directions and multi-angles.

疑诊肺栓塞患者CTPA检查指南依从性分析

目的 分析急诊疑诊肺栓塞(pulmonary embolism,PE)患者计算机断层扫描肺血管造影(CTPA)检查指南依从性。方法 本研究为单中心回顾性研究。收集2018年1月1日至2021年12月31日在北京大学第三医院急诊就诊进行CTPA检查患者的临床资料,根据CTPA检查结果分为PE组和非PE组,根据欧州心脏病学会(ESC)指南推荐,计算每位患者PE临床可能性的简化Wells评分(mWS)、改良的Geneva评分(rGS)和YEARs评分,并进行指南依从性分析。结果 共纳入1 062例疑诊PE患者,根据CTPA结果分为PE组341例,非PE组721例,CTPA阳性率32.1%,按照3种评分推荐流程进行CTPA的指南依从率分别为75.8%、79.8%及65.6%,当依从指南推荐时,可将CTPA阳性率分别提高至39.0%(P=0.002)、37.3%(P=0.018)和40.2%(P<0.001)。其中有68例患者尽管各类临床可能性评分分类至少有一种为“低危”或“不可能”,但CTPA仍为阳性结果。结论 依从指南推荐的CTPA检查流程可明显提高PE诊断阳性率,同时,应进一步关注评分阴性PE患者,从而提高诊断准确性。

自发性蛛网膜下腔出血首次血管造影阴性患者诊治进展

自发性蛛网膜下腔出血(spontaneous subarachnoid hemorrhage,sSAH)是神经外科常见的危急重症之一,目前仍有较高的致死致残率。针对该类患者,尽快完善计算机断层扫描血管造影(computed tomographic angiography,CTA)或数字减影脑血管造影(digital subtraction angiography,DSA)检查明确出血原因及部位,并根据确定的原因尽快采取手术治疗,这对改善患者预后显得尤为重要。然而,有部分患者首次血管造影存在假阴性,其原因包括多方面,如中脑周围蛛网膜下腔出血、微小动脉瘤、血栓性动脉瘤、颅内血管畸形、脊髓血管畸形以及阅片者经验等。首次造影阴性的患者必须复查,尤其是针对那些发病后头颅CT平扫高度怀疑动脉瘤患者,复查建议在早期(<2周)及中期(2~8周)进行,同时需提高对微小血管病变的警惕性及识别能力,借助于最新影像学技术,提高对病因的首次检出率。

Intentionally unilateral prostatic artery embolization:Patient selection,technique and potential benefits

BACKGROUND Prostatic artery embolization(PAE)is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia.Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries(PAs)and with the systematic attempts to catheterize the PAs of both pelvic sides.Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE.The authors hypothesized that,in selected patients,these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.AIM To describe the authors’approach for intentionally unilateral PAE(IU-PAE)and its potential benefits.METHODS This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years.IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA(subgroup A),or with markedly asymmetric prostatic enlargement,with the dominant prostatic lobe occupying at least two thirds of the entire gland(subgroup B).All patients treated with IU-PAE also fulfilled at least one of the following criteria:Severe tortuosity or severe atheromatosis of the pelvic arteries,non-visualization,or visualization of a tiny(<1 mm)contralateral PA on preprocedural computed tomographic angiography.Intraprocedural contrast-enhanced ultrasonography(iCEUS)was applied to monitor prostatic infarction.IU-PAE patients were compared to a control group treated with bilateral PAE.RESULTS IU-PAE was performed in a total 13 patients(subgroup A,n=7;subgroup B,n=6).Dose-area product,fluoroscopy time and operation time in the IU-PAE group(9767.8μGy∙m^(2),30.3 minutes,64.0 minutes,respectively)were significantly shorter(45.4%,35.9%,45.8%respectively,P<0.01)compared to the control group.Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group.In the 2 clinical failures of IU-PAE(both in subgroup A),the extent of prostatic infarction(demonstrated by iCEUS)was significantly smaller compared to the rest of the IU-PAE group.CONCLUSION In selected patients,IU-PAE is associated with comparable outcomes,but with lower radiation exposure and a shorter procedure compared to bilateral PAE.iCEUS could facilitate patient selection for IU-PAE.

股前外侧皮瓣的穿支定位及皮瓣优化设计

股前外侧皮瓣(ALTF)由中国学者首次报道以来,经过国内外学者们40年的深入研究,不断推陈出新,被誉为“万能皮瓣”。截至目前,有近20种穿支定位方法用于辅助ALTF的穿支定位,也有近20种皮瓣设计和切取方案。本文从ALTF的应用解剖、穿支定位方法以及优化设计出发,总结了作者10余年从事ALTF的穿支定位选择和多种皮瓣优化设计流程,以期进一步提高其临床应用价值。

基于计算机断层血管造影探讨颈动脉血管周围脂肪组织强化与斑块易损特征之间的关系

目的探讨颈动脉血管周围脂肪组织(PVAT)强化与易损斑块的计算机断层血管造影(CTA)特征之间的关系。方法纳入86例2022年7月至2023年8月于浙江中医药大学附属第二医院行颈动脉CTA并延迟扫描的患者。根据临床及影像表现将患者分为有症状组42例和无症状组44例。分析两组患者颈动脉斑块的CTA特征(斑块类型、斑块表面形态、斑块厚度及斑块强化率)、颈动脉周围脂肪密度(PFD)和PVAT强化率的差异性,以及颈动脉斑块易损特征与PVAT强化率的相关性。结果斑块强化率和PVAT强化率呈正相关,其中两者在延迟扫描的相关性强于常规动脉期(r=0.328、0.284,P<0.05)。在有症状组内,延迟扫描时斑块强化率与PVAT强化率呈正相关(r=0.439,P<0.05)。有症状组的斑块厚度、常规动脉期斑块强化率、延迟扫描斑块强化率、常规动脉期PVAT强化率以及延迟扫描PVAT强化率高于无症状组(Z=-2.207、-2.410、-2.376、-2.773、-3.352,P<0.05)。两名观察者间的斑块特征评估结果具有较好的一致性。结论CTA延迟扫描可提高对斑块密度与PFD测量的准确性,能在一定程度上弥补常规颈动脉CTA存在的不足;PVAT强化率与易损斑块强化率的相关性不仅对评估斑块易损性有重要提示意义,而且可能对缺血性脑卒中的发生有一定的预测和评估价值。

三维CT血管造影与平板DSA对颅内动脉瘤诊断价值的对比分析

目的对比分析多层螺旋CT三维血管造影(3D-CTA)与平板DSA对颅内动脉瘤的诊断价值。方法对44例自发性蛛网膜下腔出血(SAH)患者同时行3D-CTA及平板DSA(包括2D-DSA、3D-DSA)检查,评价不同检查方法对动脉瘤的诊断效能、3D-CTA容积再现(VR)与3D-DSA容积再现(VR)对共同检出的动脉瘤之瘤体长径差异、瘤颈及载瘤动脉清晰度。结果 44例自发性SAH患者经外科手术或血管内介入证实36例为动脉瘤患者,共46个动脉瘤(其中26例单发,10例多发)。3D-CTA共检出40例48个动脉瘤(灵敏度83.33%,特异度75%,阳性预测值75%,阴性预测值66.67%)。2D-DSA检出38例患者中44个动脉瘤(灵敏度77.78%,特异度75%,阳性预测值73.68%,阴性预测值75%)。3D-DSA最大密度投影(MIP)检出34例动脉瘤患者共44个动脉瘤(灵敏度94.44%,特异度100%,阳性预测值100%,阴性预测值100%)。3D-DSA(VR)检出36例动脉瘤患者共46个动脉瘤,无漏诊及误诊。就颅内动脉瘤的检出率方面,3D-CTA与2D-DSA、3D-DSA(MIP)的检出率差异无统计学意义(P>0.05),但3D-CTA(VR)与3D-DSA(VR)的检出率差异有统计学意义(P<0.05)。无论是≥3 mm的动脉瘤还是<3 mm的动脉瘤,3D-CTA(VR)与3D-DSA(VR)对瘤体长径的测量差异均无统计学意义(P>0.1)。在瘤颈及载瘤动脉清晰度显示方面,3D-CTA(VR)与2D-DSA和3D-DSA(VR)差异均有统计学意义(P<0.05),但3D-CTA(VR)与3D-DSA(MIP)差异无统计学意义(P>0.05)。结论 3D-CTA对瘤体长径≥3 mm的颅内动脉瘤有很高的诊断效能,可作为一种微创的常规筛查方法,但对长径<3 mm的颅内动脉瘤有较高的漏诊及误诊率,对其未发现颅内动脉瘤的SSAH患者应进一步行3D-DSA检查。

3D-CT/3D-CTA在神经外科领域的应用研究

目的评价计算机断层扫描三维重建技术(3D-CT/3D-CTA)在神经外科领域的应用价值。方法回顾性分析312例3D-CTA和3D-CT检查。阳性结果259例,其中脑血管病199例。筛检阴性53例,其中DSA、MR或手术证实41例,假阴性5例(12.2%)。结果与DSA、MR以及术中观察比较:①脑动静脉畸形3D-CTA确诊率100%,无假阳性和假阴性;②脑动脉瘤3D-CTA确诊率90.9%,假阳性4%;假阴性5.1%;③Moyamoya确诊率84.6%,对于脑底动脉环闭塞部位的判断,准确率38.5%;④脑动静脉瘘和静脉性血管畸形3D-CTA确诊率100%;⑤颅脑肿瘤与邻近骨性结构关系的确诊率100%,与邻近脑血管关系的确诊率63.2%;⑥颅、眶骨性病变确诊率100%。结论3D-CT/3D-CTA技术为颅、颈血管性病变、颅骨相关病变和颅内高血供肿瘤的影像学诊断提供了高度准确、无创性的手段。

64排螺旋CT冠脉成像与冠状动脉造影对高龄冠心病诊断的对比研究

目的：评价64排螺旋CT冠脉成像（64-SCTCA）对高龄冠心病患者冠状动脉狭窄病变的临床诊断价值。方法：2010年1月~2011年1月期间住院的16例临床诊断或疑诊冠心病的高龄（≥60岁）患者,先后行64-SCTCA和冠状动脉造影（CAG）检查,参照美国心脏协会冠状动脉分段法对冠状动脉进行分段,评价64-SCTCA诊断高龄冠心病患者冠状动脉各节段狭窄病变的敏感性、特异性、准确性及阳性、阴性预测值。结果：（1）在CAG可清晰显影的144个节段中,64-SCTCA可清晰辨认和评价的占139段（96.53%）,另外5段（3.47%）显影不清。左主干、前降支及左回旋支可评价节段的比例显著高于右冠状动脉（χ2=10.36,P=0.016）,同一支血管中近、中、远段可评价的比例无显著性差异（P〉0.05）。（2）64-SCTCA诊断冠心病的敏感度、特异度、准确度、阳性和阴性预测值分别为88.89%、71.43%、81.25%、80.00%、83.33%。按可评价节段计算,64-SCTCA诊断冠状动脉各节段有意义狭窄病变总的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为85.00%、97.58%、95.83%、85.00%、97.58%。（3）按可评价节段计算,64-SCTCA检出存在有意义病变与CAG相比无显著性差异,检测左主干、左前降支、左回旋支和右冠状动脉各节段病变及同一支血管近、中、远段的假阳性率比较,差异均无统计学意义（P〉0.05）。结论：64-SCTCA与CAG检查结果高度相近,对冠状动脉狭窄病变有较好的诊断价值,其检测左主干、左前降支和左回旋支病变的价值高于右冠状动脉,对临床诊断冠心病有着重要的参考价值。

3D-CTA、2D-DSA及3D-DSA对颅内动脉瘤诊断价值的对比研究

目的对比分析64排3D-CTA、2D-DSA及3D-DSA对颅内动脉瘤的影像学诊断价值。方法筛选31例疑似颅内动脉瘤破裂所致的蛛网膜下腔出血病例进行回顾性研究,收集完整的3D-CTA、2D-DSA、3D-DSA及手术资料。比较3D-CTA、2D-DSA、3D-DSA对颅内动脉瘤检查的灵敏度与特异度及其对颅内动脉瘤形态及瘤颈的显示情况。结果 31例蛛网膜下腔出血患者经3D-DSA共检出35枚颅内动脉瘤,3D-CTA及2D-DSA均检出34枚颅内动脉瘤。3D-CTA检查动脉瘤的灵敏度为97.06%,特异度为88.89%。三种检查手段的ROC曲线及其曲线下面积显示3D-CTA与3D-DSA的灵敏度与特异度无显著性差异,但明显高于2D-DSA。3D-DSA及3D-CTA均能良好显示检出动脉瘤的几何形态及动脉瘤瘤颈情况,效果明显优于2D-DSA(P<0.05)。结论利用3D-CTA可安全、有效地检查颅内动脉瘤,其检查效果优于2D-DSA,可作为颅内动脉瘤检查及随访的首选影像学手段。对于临床高度怀疑颅内动脉瘤且3D-CTA阴性的患者,可推荐进一步行3D-DSA检查。