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256排双源CTA与3DDSA对颅内小动脉瘤 的对比分析及临床 意义

作者:黄文浩 冯广森

所属单位:郑州大学第二附属医院(河南 郑州 450014)

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摘要

目的 对比分析双源CTA与3D-DSA 对颅内小动脉瘤的检出率及临床价值。方 法 回顾性分析本院2015年7月-2017年12 月65例疑似颅内小动脉瘤患者,对其双源 CTA和DSA检查资料进行对比分析,记录小 动脉瘤发生的位置、大小、数目及瘤颈宽 度,并分析双源CTA诊断颅内小动脉瘤的 敏感度、特异度及约登指数。结果 32例 确诊为小动脉瘤患者中,双源CTA诊断出 31例患者35枚小动脉瘤,其中34枚动脉瘤 检出结果与DSA一致,CTA检出动脉瘤情况 与DSA不存在显著差异(P>0.05),无统 计学意义。CTA与DSA检出动脉瘤的位置、 大小、数目及瘤颈宽度基本相符。结论 双源CTA对诊断颅内小动脉瘤具有良好敏 感度及特异度,双源CTA相对DSA检查,具 有无创、快捷、风险小、费用低的特点, 可作为筛查颅内小动脉瘤的首选方法,诊 断结论对进一步临床治疗具有重要意义。

Objective To compare the detection rate and clinical value of dual-source CTA and 3D-DSA for intracranial small aneurysms. Methods Retrospective analysis of 35 cases of suspected intracranial small aneurysms in our hospital from July 2015 to December 2017,comparison and analysis of the double-source CTA and DSA examination data, and record the location, size, number and neck width of small aneurysms, to analyze the sensitivity, specificity and YouDen Index of the diagnosis of intracranial small aneurysms. Results 30 patients were confirmed with intracranial small aneurysms, dual source CTA diagnosed 31 small aneurysms in 29 patients, in all aneurysms, the results of 30 aneurysms were consistent with DSA, there was no significant difference between CTA and DSA (P>0.05),no statistical significance. The location, size, number and neck width of the aneurysms were basically consistent with that of DSA. Conclusion Dual-source CTA has good sensitivity and specificity for diagnosing intracranial small aneurysms, to compare with DSA, Dual-source CTA is relatively noninvasive, fast, low risk and low cost, it can be the preferred method for screening intracranial small aneurysms. Diagnosis conclusion is of great significance for further clinical treatment.

【关键词】颅内小动脉瘤;双源CTA; DSA;对比分析;临床意义

【中图分类号】R743.4;R445.3;R445.4

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.05.003

前言

颅内小动脉瘤(直径≤5mm)[1]是指脑动脉局限性扩大造成动脉壁的 一种瘤样突起,其发生率约5%-8%[2],主要发病年龄40-60岁,女性多 见,是导致蛛网膜下腔出血的最重要原因之一[3]。颅内动脉瘤破裂出 血的致残率和死亡率较高,再次出血死亡率高达80%[4],因此早发现, 早治疗对于动脉瘤患者至关重要。本文通过双源CTA与DSA的对比分 析,结论显示双源CTA诊断动脉瘤的敏感性及特异性可与DSA相媲美, 且具有方便快捷、无创伤、费用低、风险小等优点,近年,CTA已广泛 应用于诊断动脉瘤[5]。研究表明,256排双源CTA能够准确诊断出颅内 小动脉瘤发生的位置,大小,形态及瘤颈宽度,对于颅内小动脉瘤的 筛查及诊断有重要意义,可作为颅内动脉瘤的筛查及治疗后复查的首 选方法,具有重要的临床价值,为临床治疗提供重要依据。