硬脑膜动静脉瘘：4D CTA和DSA在诊断与分型中的对照研究

摘要

Objective To compare four-dimensional CT angiography(4D-CTA)with digital subtraction angiography(DSA) for demonstrating the location and classification of dural arteriovenous fistula(DAVF).Methods Thirty-four patients with DAVF underwent 320-detector row 4D-CTA within 2 days before DSA.All CTA images were independently reviewed by 2 readers for the presence,location,and classification of DAVF using DSA as the gold standard and Borden classification.Results The DAVF in all 34 patients were demonstrated on 4D-CTA and DSA.The DAVF was located on DSA in the dural sinuses(12),cavernous sinus(7), tentorium(8),basilar venous plexus(6),and falx cerebri(1).The classification on 4D-CTA in 32 patients was concordant with that on DSA as Borden I(18),II(7),III(7).In 2 patients with Borden II DAVF,retrograde venous filling was not detected by both readers on 4D-CTA and the DAVF was incorrectly classified as Borden I.Conclusions 4D-CTA can reliably demonstrate DAVF.%目的：4D CTA与DSA在硬脑膜动静脉瘘诊断，部位及分型中的对比研究。方法34例硬脑膜动静脉瘘患者行320排动态容积CT 4D CTA及DSA检查，4D CTA与DSA检查间隔时间均小于2 d。所有图像以DSA作为金标准由2位神经放射学专家对诊断，位置及分型进行独立的评估。硬脑膜动静脉瘘的位置主要分为：硬膜窦区、海绵窦区、天幕区、基底静脉丛区和大脑镰区，分型参照Borden分型。结果依据4D CTA和DSA，34例患者均分别被诊断为硬脑膜动静脉瘘。位置分布为：硬膜窦区（12例），海绵窦区（7例），天幕区（8例），基底静脉丛区（6例）和大脑镰区（1例）。对于DSA图像的Borden分型结果为：Ⅰ型18例，Ⅱ型9例，Ⅲ型7例。对于4D CTA的分型结果，其中32例患者的结果与DSA一致，另外2位患者，DSA评估为BordenⅡ型，而4D CTA图像因静脉反流被漏诊而误认为BordenⅠ型。结论4D CTA可以作为临床筛查及诊断硬脑膜动静脉瘘的主要方法，用于评估硬脑膜动静脉瘘的诊断，部位及分型。