颅内动脉瘤诊断及治疗的影像学评价对比研究

目的:评价CTA在诊断及治疗颅内动脉瘤中的临床应用价值。方法:97例临床疑似颅内动脉瘤患者中首先随机选择CTA及MRA两种无创伤检查中的一种,随后均行DSA检查。以DSA和外科手术确诊为参考,比较CTA,MRA及DSA在诊断颅内动脉瘤中的优势和不足。选择相应治疗后,行CTA+DSA或MRA+DSA复查,评价动脉瘤的残留情况。结果:①50例行CTA+DSA检查组中,确诊阳性病例46例。CTA检测的特异性、灵敏性及准确性分别为66.67%、100%和98%。阴性及阳性预测率分别为100%和97.92%。DSA检测的特异性、灵敏性及准确性分别为66.67%、95.74%和94%。阴性及阳性预测率分别为50%和97.83%。②47例行MRA+DSA检查组中,确诊阳性病例45例。MRA检测的特异性、灵敏性及准确性分别为50%、97.67%和93.62%。阴性及阳性预测率分别为66.67%和95.45%。DSA检测的特异性、灵敏性及准确性分别为66.67%、97.73%和95.74%。阴性及阳性预测率分别为66.67%和97.73%。③48例接受动脉瘤颈夹闭术的患者行CTA+DSA复查,以DSA为标准,CTA评价动脉瘤残留的特异性、灵敏性及准确性分别为97.73%、100%和97.78%。42例接受可解脱弹簧圈治疗的患者行MRA+DSA复查,以DSA为标准,MRA评价动脉瘤残留的特异性、灵敏性及准确性分别为100%、66.67%和97.5%。结论:CTA诊断颅内动脉瘤的特异性、灵敏性及准确性稍优于DSA,MRA对于颅内动脉瘤的诊断方面稍低于DSA;同时CTA及MRA均可清晰显示动脉瘤的三维结构及空间关系;综合比较,我们认为CTA对于动脉瘤的诊断及手术方案的确定能提供更多的信息,并可作为术后较为理想的随访影像学检查方法。

Comparative Study of Imaging in Diagnosis and Therapy of Intracranial Aneurysms

Objective: To evaluate the clinical value of CTA(CT Angiography, CTA) in the diagnosis and treatment of intracranial aneurysms. Methods: 97 cases of patients with clinically suspected of intracranial aneurysms were randomly detected by one of the non-invasive examination CTA and MRA first, and then underwent a DSA examination. Comparing with DSA and surgical diagnosis, we discussed the advantages and disadvantages of CTA, MRA and DSA. After acceptance of the appropriate treatment, patients underwent a CTA + DSA examination or a MRA + DSA examination, and evaluate of residual aneurysm case. Results:(1) 50 patients in CTA + DSA inspection group, 46 cases were confirmed as positive cases. The specificity, sensitivity and accuracy of CTA detection were: 66.67%, 100%, and 98%. Negative and positive predictive values were: 100%, 97.92%. The specificity, sensitivity and accuracy of DSA detection were: 66.67%, 95.74%, and 94%. Negative and positive predictive values were: 50%, 97.83%.(2) 47 patients in MRA + DSA inspection group, 45 cases were confirmed as positive cases. The specificity, sensitivity and accuracy of MRA detection were: 50%, 97.67%, and 93.62%. Negative and positive predictive values were: 66.67%, 95.45%. The specificity, sensitivity and accuracy of DSA detection were: 66.67%, 97.73%, and 95.74%. Negative and positive predictive values were: 66.67%, 97.73%.(3) 48 patients who underwent aneurysm clipping surgery detected by CTA + DSA examination, and DSA as the standard, CTA evaluation of residual aneurysm specificity, sensitivity and accuracy were: 97.73%, 100%, and 97.78%. 42 cases accepted relief coil therapy detected by MRA + DSA examination,and DSA as the standard, MRA evaluation of residual aneurysm specificity, sensitivity and accuracy were: 100%, 66.67%, and 97.5%. Conclusion: CTA diagnosis of intracranial aneurysms specificity, sensitivity and accuracy slightly better than DSA, MRA for the diagnosis of intracranial aneurysms is slightly lower than the DSA; while CTA and MRA can clearly show the three-dimensional structure of the aneurysm and spatial relationships; comprehensive comparison, we believe that CTA for the diagnosis and determine aneurysm surgery programs can provide more information. And CTA can be used as an ideal follow-up after imaging methods.