3D-DA与3D-MSCTA对颅内动脉瘤诊断价值探讨

摘要

目的 探讨三维数字血管造影(3D-DA)与三维多层螺旋CT血管造影(3D-MSCTA)在颅内动脉瘤诊断中的作用和意义.方法 回顾性分析2008年12月- 2010年12月41例疑似颅内动脉瘤患者的常规DSA、3D-DA及3D-MSCTA影像资料,分别由2名放射科医师采用双盲法进行分析并咨询神经外科医师.评估两种方法检测动脉瘤的灵敏度、特异度、阳性预测值和阴性预测值,并以常规DSA影像和手术所见作为参考.结果 41例患者经过外科手术或DSA证实颅内动脉瘤患者35例,共发现44个动脉瘤,其中单发动脉瘤28例,2个动脉瘤5例,3个动脉瘤2例.3D-MSCTA检查发现41个动脉瘤,3D-DA发现44个动脉瘤,两种方法对检测颅内动脉瘤的灵敏度、特异度、阳性预期值、阴性预期值分别为93.2%、85.7%、97.6%、66.7%和100%、85.7%、97.8%、100%.3D-MSCTA与3D-DA都能清晰显示动脉瘤的瘤体大小、瘤颈、瘤体指向、载瘤动脉及动脉瘤与邻近血管和骨性组织间的解剖关系.3D-DA在多发的复杂、微小动脉瘤细节显示上更具优势.结论 3D-MSCTA具有安全、快捷、无创、准确等特点,能清楚显示颅内动脉瘤的形态特征和邻近解剖关系,可作为颅内动脉瘤的首选检查方法.3D-DA能够为颅内动脉瘤的治疗提供更为全面、精准的图像信息.%Objective To discuss the clinical value and significance of three-dimensional multi-slice spiral CT angiography (3D-MSCTA) and three-dimensional digital angiography (3D-DA) in detecting and diagnosing intracranial aneurysms. Methods During the period from Dec. 2008 to Dec. 2010, a total of 41 consecutive patients with suspected intracranial aneurysms were encountered in the hospital. Routine DSA, 3D-DA and 3D-MSCTA were performed in all patients. The imaging material was separately reviewed and analyzed by two radiologists by using double-blind method. When needed, consultation with neurosurgical physicians was made. The sensitivity, specificity, and positive and negative predictive values in the detection of aneurysms by 3D-MSCTA and 3D-DA were determined. Taking routine DSA manifestations and surgical findings as the reference standard, the results were analyzed. Results Of the 41 patients with suspected intracranial aneurysms, a total of 44 aneurysms were found in 35 patients. The patients had single aneurysm (n = 28), two aneurysms (n = 5) or three aneurysms (n = 2). The sensitivity, specificity, positive and negative predictive values obtained by 3D-MSCTA were 93.2%, 92.2%, 85.7% and 97.6% , respectively, while those obtained by 3D-DA were 100%, 98%, 97.8% and 100%, respectively. When well performed, 3D-DA could clearly display the multiple and complex-shaped intracranial aneurysms as well as very small aneurysms. Conclusion Being a safe, quick, noninvasive and accurate technique, 3D-MSCTA should be regarded as the examination of first choice for the diagnosis of intracranial aneurysms. The imaging features of intracranial aneurysms and the relationship between the lesions and surrounding structures can be clearly displayed on 3D-MSCTA. 3D-DA can provide more comprehensive and detailed imaging information, which is very useful in making the clinical therapeutic plan.