双能量减影CT血管成像诊断颅内动脉瘤的价值

摘要

Objective To evaluate the clinical value of dual-energy computed tomography angiography ( DE-CTA) in the diagnosis of intracranial aneurysm. Methods 60 patients clinically suspected of intracranial aneurysms underwent DE-CTA and 3D-DSA. Dualenergy mode at tube voltages of 140 kV and 80 kV was used in enhanced scanning. The data of two different energy were collected only at one scanning. The image data were post-processed including direct removed-bone digital subtraction( dual-energy subtraction) with 80 kV and 140 kV enhanced scanning data that had different energy, and saving the data of subtraction. Volume render( VR) and maximum intensity projection( MIP) reconstruction were done. All cases were confirmed by surgery . The accuracy of detection of aneurysm with CTA was analyzed compared with 3D-DSA and surgical evidence . Results 40 aneurysms in 60 patients were detected by DE-CTA . The mean long , short axis and size of neck of aneurysms were ( 5. 54±3. 28 ) rnm , ( 4. 67±3. 12 ) mm and ( 3. 22± 1. 31) mm , respectively, 1 aneurysm was missed at the initial evaluation by DE-CTA. Using surgical evidence as the standard of reference,the sensitivity and specificity of DE-CTA to detect intracranial aneurysms were 97. 5 ％ and 100％ , respectively . 41 aneurysms in 60 patients were correctly detected by 3D-DSA , the mean long , short axis and size of neck of aneurysms were ( 5. 47±3. 33) mm, (4. 60± 3. 31) mm and (3. 17±1. 54) mm, respectively. Excellent correlation was found between the DE-CTA and 3D-DSA in the diagnosis of intracranial aneurysms( r= 0. 954 , 0. 957 , 0. 869 , P = 0. 000 ). Conclusion DE-CTA has a high sensitivity and specificity for the detection of intracranial aneurysm.%目的 探讨双源CT双能量减影CT血管成像(DE-CTA)诊断颅内动脉瘤的价值.方法 对60例临床怀疑颅内动脉瘤患者同时进行CT血管成像及3D-DSA检查(2种方法间隔时间均在l周内),CT扫描采用双能量程序,1次扫描采集2个不同能量的数据.所得原始数据的后处理采用80 kV及140 kV 2个不同能量的数据进行直接去骨减影(即双能量减影),并保存减影后数据.所有病例均完成容积显示(VR)和最大密度投影(MIP).并对动脉瘤部位、数目、形态、瘤颈显示程度、瘤颈大小及瘤体长径和短径进行比较研究.全部病变结果均经手术证实.结果 DE-CTA共检出40个动脉瘤,漏诊1个动脉瘤,40个动脉瘤平均长轴、短轴及瘤颈大小分别为(5.54±3.28) mm、(4.67±3.12) mm和(3.22±1.31) mm.以DSA结果为诊断标准,DE-CTA诊断动脉瘤的敏感性、特异性分别为97.5%、100%.3D-DSA检出41个动脉瘤,41个动脉瘤平均长轴、短轴及瘤颈大小分别为(5.47±3.33) mm、(4.60±3.31) mm和(3.17±1.54) mm.2种技术之间有很好的相关性(r=0.954、0.957、0.869;P=0.000).结论 双能量CT血管成像诊断颅内动脉瘤有较高的敏感性及特异性.