不同方式诊断脑动脉瘤的效果对比(DE-CTA、2D-DSA、3D DCE-MRA)

摘要

目的:研究探讨二维数字减影血管造影(2D-DSA)、双能量CT血管造影(DE-CTA)及三维动态增强磁共振血管造影(3D DCE-MRA)三种方式诊断脑动脉瘤的临床应用价值.方法:选取2012年01月至2016年05月于医院住院诊治的60例疑诊为脑动脉瘤的蛛网膜下腔出血(SAH)患者,对所有患者行DE-CTA、3D DCE-MRA、2D-DSA检查,行三维数字减影血管造影(3D-DSA)检查进行确诊,观察对比分析三种不同的检查方式诊断脑动脉瘤的差异.结果:在脑动脉瘤瘤体的短径及长径的测量方面,三种检查方式的诊断之间无显著性的差异(P>0.05);在脑动脉瘤瘤颈的横径的测量方面,DE-CTA与3D DCE-MRA两种检查方式之间无明显的差异(P>0.05),而两者与2D-DSA之间表现出显著的差异性(P<0.05);在动脉瘤的瘤颈与邻近载瘤动脉间的空间结构显示方面,三种检查方式之间相比较差异较大,具有统计学意义(P<0.05).结论:DE-CTA及3D DCE-MRA作为一种无创性的筛查手段,有漏诊可能,应考虑进一步行3D-DSA检查明确.同时,2D-DSA作为3D-DSA及后期介入治疗的基础,能提供更详细的脑血管血流动力学方面的信息,具有不可替代的作用.%Objective: To study the clinical application value of 2D - DSA, DE - CTA and 3D DCE-MRA in the diagnosis of aneurysm. Method: 60 patients with clinicaly suspected SAH confirmed from January 2012 to May 2016 in our hospital were selected. After the examination of DE–CTA, 3D DCE-MRA and 2D–DSA, all the patients were confirmed with 3D - DSA. The diagnosis results based on three examination methods were observed. Result: The diagnosis rate of aneurysm based on three methods was not significantly different(P>0.05); the measurement accuracy of long and short diameter of aneurysm based on three methods was not significantly different(P>0.05); the measurement accuracy of transverse diameter of aneurysm based on DE - CTA and 3D DCE-MRA was not significantly different(P>0.05); the measurement accuracy on the transverse diameter of aneurysm based on DE - CTA and 3D DCE-MRA was significantly different from that of 2D - DSA(P<0.05); the spatial structure imaging of aneurysm neck and parent artery based on three methods was significantly different(P<0.05). Conclusion: Compared with DE - CTA and 2D - DSA, 3D DCE-MRA has a better spatial structure imaging in the aneurysm neck and parent artery; the measurement accuracy of transverse diameter of aneurysm based on 3D DCE-MRA and DE–CTA is better than that of 2D–DSA; the diagnosis rate of aneurysm based on three methods is not significantly different.