3D-CTA与3D-DSA对颅内小动脉瘤诊断价值比较

摘要

Objective To investigate the diagnoctic value of three-dimensional spiral CT angiography (3D-CTA) and three-dimensional digital subtraction angiography(3D-DSA) in diagnosis of intracranial small aneurysms.Methods The clinical data of 30 patients with intracranial aneurysm rupture caused by subarachnoid hemorrhage who underwent 3D-CTA and 3D-DSA examination in our hospital from January 2016 to January 2017 were retrospectively analyzed. These patients were definitely diagnosed by surgical open cranium occlusion or vascular intervention surgery,who were divided into CTA group and DSA group.The detection accuracy of two kinds of examination methods in diagnosis of intracranial small aneurysms with different sizes and in different positions was analyzed and compared between the two groups.Results Among 30 patients with intracranial small aneurysms,35 small aneurysms were found including 26 cases with single microaneurysm, 3 cases with 2 aneurysms and 1 cases with 3 small aneurysms,in which,30 small aneurysms were detected by CTA,with accuracy rate being 85.7%, and 5 small aneurysms were missed diagnosed, with false negative rate (missed diagnosis rate) being 14.3%, moreover,4 small aneurysms were false positive,with misdiagnosis rate being 10.3%. However 35 small aneurysms were detected by DSA,with accuracy rate being 100%,and false negative rate(missed diagnosis rate) was 0,and 1 small aneurysm was false positive,with misdiagnosis rate being 2. 7%. Among the missed aneurysms in CTA group, 3 microaneurysms diameter was less than 3mm(1 piece in internal carotid artery,1 piece in posterior cerebellum artery and 1 piece in posterior communicating artery),moreover,the other 2 microaneurysms diameter was between 3mm~5mm (1 piece in internal carotid artery and 1 piece in anterior communicating artery). The detection rate of 3D-CTA and 3D-DSA in diagnosis of small aneurysms (3mm ~5mm) was 92.6% and 100%,respectively,there was no significant difference in the detection rate between two detection methods (P >0.05). In addition the detection rate of 3D-CTA and 3D-DSA in diagnosis of small aneurysm (less than 3mm) was 62.5% and 100%, respectively, there was a significant difference in the detection rate between two detection methods (P <0.05). Conclusion In diagnosis of small intracranial aneurysms (3mm ~5mm), 3D-CTA is a noninvasive,fast,safe and reliable means of first choice of imaging examination, however,in diagnosis of small intracranial aneurysms (less than 3mm), 3D-CTA has higher misdiagnosis rate and missed diagnosis rate. Moreover the accuracy rate of 3D-DSA in diagnosis of intracranial small aneurysms is significantly higher than that of 3D-CTA,and 3D-DSA can provide more information for further treatment of small aneurysms.%目的 探讨三维螺旋CT血管成像(3D-CTA) 与三维数字减影血管造影(3D-DSA)对颅内小动脉瘤的诊断价值.方法 回顾性分析收治的30例颅内小动脉瘤破裂导致蛛网膜下腔出血的患者的头颅3D-CTA及3D-DSA图像,3D-CTA图像及3D-DSA图像均由1名副高以上影像诊断医师及1名高年资神经介入医师进行阅读判断,以外科开颅夹闭或血管介入手术确诊为标准,对比分析二种检查手段对不同位置、不同大小的颅内小动脉瘤的检出的准确性.结果 30例患者共发现35枚小动脉瘤(26例为单发,3例为2个小动脉瘤,1例为3个小动脉瘤),CTA共检出30枚,准确率85.7%,漏诊5枚,假阴性率(漏诊率)14.3%,假阳性4个,误诊率为10.3%;DSA共检出35枚,准确率100%,假阴性率(漏诊率)0,假阳性1个,误诊率2.7%.其中CTA漏诊的小动脉瘤中3枚直径为≤3 mm的微小动脉瘤(颈内动脉1枚,小脑后下1枚,后交通1枚);2枚直径3~5 mm(颈内动脉1枚,前交通1枚).3D-CTA与3D-DSA对小动脉瘤(3 mm~5 mm)的检出率分别为93.3%和100%,2组检出率差异无统计学意义(P>0.05);对微小动脉瘤(≤3 mm)的检出率分别为62.5%和100%,2组检出率差异有统计学意义(P<0.05).结论 对颅内小动脉瘤(3 mm~5 mm)的诊断,3D-CTA是无创、快速及安全可靠的首选影像学检查手段,但对于颅内微小动脉瘤(≤3 mm)的诊断上漏诊率及误诊率较高;而3D-DSA对颅内小动脉瘤的诊断准确性明显高于3D-CTA,并且3D-DSA可以为临床下一步治疗小动脉瘤提供更多的信息.