摘要
目的:探讨三维CT血管造影(3D-CTA)对急性自发性颅内出血(ICH)的病因诊断价值。方法:回顾性分析自2013年11月至2014年9月间在本院经CT证实为急性自发性ICH和253例患者其影像学资料,所有患者行3D-CTA、数字减影血管造影(DSA)检查。3D-CTA后处理图像与DSA图像由2位放射科医师用双盲法进行分析。结果:253例患者中以脑实质血肿为主27例,脑室系统积血12例,以蛛网膜下腔出血(SAH)为主214例。在DSA下,共发现畸形血管团17例、烟雾病(MMD)13例、动脉瘤178例(单发153例,多发25例)。在3D-CTA检查中,发现所有脑室内出血患者的病因,其敏感性、特异性、阳性预测值及阴性预测值均为100.0%;脑实质出血患者漏诊2例畸形血管团,直径都<2 mm,其敏感性、特异性、阳性预测值及阴性预测值分别为90.9%、100.0%、100.0%、71.4%;而在SAH患者中,漏诊4例,误诊1例微小动脉瘤,其敏感性、特异性、阳性预测值及阴性预测值分别为97.8%、97.8%、99.4%、90.5%。结论:3D-CTA对急性自发性ICH病因诊断具有很高的敏感性和特异性,可作为急性自发性ICH病因筛查的首选诊断方法。
Objective： To assess the diagnostic accuracy of 64-slice three dimensional computed tomographic angiography（3D-CTA） for the etiology of spontaneous intracranial hemorrhage（ICH）. Methods： From November 2013 to September 2014, 253 consecutive patients with ICH admitted to emergency department were included in this study and successively underwent 3D-CTA and DSA. All of the images of 3D-CTA and DSA were independently analysed by two neuroradiologists blinded, respectively. Then evaluate the accuracy of 3D-CTA for the etiology of ICH, compared with DSA as reference standard. Results： Among 253 patients, 27 patients were parenchymal hematoma, 12 patients were hemorrhage in ventricle system, and 214 patients were subarachnoid hemorrhage. DSA showed intracranial arteriovenous malformation in 17 patients, moyamoya disease in 13 patients, and intracranial aneurysm in 178 patients. The sensitivity and specificity of 64-slice 3D-CTA in the detection of the causes of ventricle system hemorrhage were both 100.0%, while in detection of the causes of parenchymal hematoma, the sensitivity and specificity were 90.9% and 100.0% respectively. Two patients with intracranial arteriovenous malformation less than 2 mm in diameter were omission. However, 3D-CTA missed 4 aneurysms, and misdiagnosed a small aneurysum in patients with subarachnoid hemorrhage, which made the sensitivity and specificity of 3D-CTA in detection of the causes of SAH lower（97.8% and 97.8% respectively）. Conclusion： 3D-CTA has a high sensitivity and specificity for intracranial vascular disease, and can be used as the first choice of screening suspected intracranial aneurysms in emergency department. Moreover, 3D-CTA plays an important supplementary role in whole brain digital subtraction angiography for guiding aneurysm treatment.
出处
《温州医科大学学报》
CAS
2015年第12期907-910,共4页
Journal of Wenzhou Medical University
基金
温州市公益性科技计划项目(Y20140733)
关键词
颅内出血
三维CT血管造影
数字减影血管造影
intracranial hemorrhage
three dimensional computed tomographic angiograph
digital subtraction angiography
