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Application of three dimensional computed tomographic angiography to acutely ruptured intracranial aneurysms associated with clinical diagnosis and treatment
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- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF NEUROSURGERY
- Issue:
- 6
- DOI:
- 10.3760/j.issn:1001-2346.2007.06.002
- Key Word:
- 颅内动脉瘤;三维CT血管造影;诊断
Abstract： 目的 探讨三维CT血管造影(3D-CTA)在颅内动脉瘤破裂急性期的临床诊断价值.方法 148例疑为颅内动脉瘤破裂的自发性蛛网膜下腔出血患者,进行3D-CTA检查,时间分别在发病后2h到4d;其中6例在3D-CTA之前行数字减影脑血管造影(2D-DSA)检查,142例在3D-CTA之后行DSA检查,扫描图像后经计算机工作站处理.原始图像三维后处理技术采用容积重建(VR)和最大密度投影(MIP),以VR为主.后处理图像与DSA图像分别由两位放射科医生和神经外科医生用双盲法进行分析.对动脉瘤治疗采用夹闭和血管内栓塞两种技术.结果 经3D-CTA、DSA和手术或栓塞证实共发现112例130个动脉瘤,大小自1.1～28 mm,其中单发动脉瘤97例,多发15例33个动脉瘤.在112例动脉瘤中,3D-CTA发现112例128个动脉瘤,漏诊多发动脉瘤中的2个,敏感度为98.5%,特异度94.7%,准确度97.6%,阳性预测值98.5%,阴性预测值94.7%;而DSA发现动脉瘤109例127个动脉瘤,漏诊3例3个动脉瘤,敏感度为97.7%,特异度100%,准确度98.2%,阳性预测值100%,阴性预测值为92.3%.在3D-CTA上均可清晰或较清晰显示出瘤颈与载瘤动脉的关系,占98.4%;而DSA能清晰显示瘤颈与载瘤动脉关系仅占40.9%,两者有统计学意义(χ2=5.545,P＜0.05).结论 3D-CTA对颅内动脉瘤具有极高的敏感性和特异性,并具有快捷、经济和相对无创等优点,对颅内动脉瘤破裂急性期的诊断优于2D-DSA.
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