64排螺旋CT脑血管造影在动脉瘤性蛛网膜下腔出血诊断中的应用

doi:10.7517/issn.1674-0475.200205

摘要/Abstract

摘要： 为了探究64排螺旋CT脑血管造影在动脉瘤性蛛网膜下腔出血诊断中的应用价值，本文选取了152例动脉瘤患者，分析了64排螺旋CT脑血管造影对动脉瘤性蛛网膜下腔出血的诊断结果，评价了其诊断的灵敏度、特异性和准确性。结果显示，与数字减影血管造影检查结果相比，64排螺旋CT脑血管造影对动脉瘤性蛛网膜下腔出血患者的诊断灵敏度、特异性、准确率、阳性预测值和阴性预测值均无显著性差异（P>0.05）；CT脑血管造影结果与手术中实际测量的动脉瘤各项数据也无显著性差异（P>0.05）；而且对患者动脉瘤细节的显示优于数字减影血管造影，差异具有统计学意义（P<0.05）。本研究揭示了64排螺旋CT脑血管造影对于动脉瘤性蛛网膜下腔出血的诊断具有良好的效果，而且能够更好地展示患者的动脉瘤细节，对于指导制定脑动脉瘤手术方案有一定帮助，适合在临床推广使用。

关键词: 螺旋CT, CT血管造影, 脑动脉瘤, 蛛网膜下腔出血

Abstract: In order to explore the diagnostic effect of 64-slice spiral CT angiography in aneurysmal subarachnoid hemorrhage, 152 cases of patients with aneurysms were performed with 64 row spiral CT cerebral angiography and digital subtraction angiography. We analyzed the results of 64 row spiral CT cerebral angiography on the diagnosis of aneurysmal subarachnoid hemorrhage, and evaluated its diagnostic sensitivity, specificity and accuracy. The clinical data showed that there was no significant difference between 64-slice spiral CT angiography and digital subtraction angiography in their diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value in patients with aneurysmal subarachnoid hemorrhage (P>0.05). In addition, the results of 64-slice spiral CT cerebral angiography showed no significant difference with the aneurysm data measured during surgery (P>0.05). Moreover, 64-slice spiral CT angiography showed better aneurysm details than digital subtraction angiography (P<0.05). It was indicated that 64-slice spiral CT angiography has a good application value for the diagnosis of aneurysmal subarachnoid hemorrhage, and can better display the details of patients' aneurysms, which is helpful for guiding the development of surgical plans for brain aneurysms and suitable for clinical promotion.

Key words: spiral CT, CT angiography, brain aneurysm, subarachnoid hemorrhage

温见春, 张幸. 64排螺旋CT脑血管造影在动脉瘤性蛛网膜下腔出血诊断中的应用[J]. 影像科学与光化学, 2020, 38(4): 729-733.

WEN Jianchun, ZHANG Xing. The Diagnostic Effect of 64-slice Spiral CT Angiography in Aneurysmal Subarachnoid Hemorrhage[J]. Imaging Science and Photochemistry, 2020, 38(4): 729-733.

参考文献

[1] 常义, 马骏, 刘宏毅. 脑动脉瘤破裂致蛛网膜下腔出血诊治中的有关问题[J]. 临床神经外科杂志, 2008, 5(2):103.
[2] 邢吉军, 李强. 脑动脉瘤性蛛网膜下腔出血预后因素多重对应分析[J]. 现代实用医学, 2010, 22(2):169-170.
[3] Vilalta J. Prognosis of patients treated with the clipping of brain aneurysm following subarachnoid hemorrhage[J]. Medicina Clinica, 1999, 113(12):478.
[4] Kumar A, Brown R, Dhar R, et al. Early vs delayed cerebral infarction after aneurysm repair after subarachnoid hemorrhage[J]. Neurosurgery, 2013, (4):4.
[5] Kumar A, Niknam K, Lumba-Brown A, et al. Practice variation in the diagnosis of aneurysmal subarachnoid hemorrhage:a survey of US and Canadian emergency medicine physicians[J]. Neurocritical Care, 2019, 321:321-328.
[6] Abiko S, Okamura T, Kurokawa Y, et al. Diagnosis and treatment of nontraumatic intracranial dissecting aneurysm presenting with subarachnoid hemorrhage[J]. Clinical Neurology and Neurosurgery, 1997, 99(Sup1):S193.
[7] Katz D A, Marks M P, Napel S A, et al. Circle of Willis:evaluation with spiral CT angiography, MR angiography, and conventional angiography[J]. Radiology, 1995, 195(2):445-449.
[8] Velthuis B K, Rinkel G J, Ramos L M, et al. Subarachnoid hemorrhage:aneurysm detection and preoperative evaluation with CT angiography[J]. Radiology, 1998, 208(2):423-430.
[9] Röhnert W, Hänig V, Hietschold V, et al. Detection of aneurysm in subarachnoid hemorrhage:CT angiography vs. digital subtraction angiography[J]. Aktuelle Radiologie, 1998, 8(2):63-70.
[10] Grasso G, Alafaci C, Macdonald R L. Management of aneurysmal subarachnoid hemorrhage:state of the art and future perspectives[J]. Surgical Neurology International, 2017, 8:11.
[11] Jayaraman M V, Haas R A, Do H M, et al. Should CT angiography be routinely used in patients suspected of having aneurysmal subarachnoid hemorrhage? No![J]. Radiology, 2010, 254(1):314-315.
[12] Damani R H, Mayer S, Dhar R, et al. Common data element for unruptured intracranial aneurysm and subarachnoid hemorrhage:recommendations from assessments and clinical examination workgroup/subcommittee[J]. Neurocritical Care, 2019, 30:28-35.
[13] Etminan N, Macdonald R L. Management of Aneurysmal Subarachnoid Hemorrhage[M]. Berlin:Springer, 2017.
[14] Nguyen H, Doan N, Gelsomino M, et al. Blunt traumatic brain injury patients:a role for CT angiography of the head to evaluate non-traumatic etiologies?[J]. World Neurosurgery, 2017, 101:506.
[15] Wong G K C, Daly J J, Rhoney D H, et al. Common data elements for unruptured intracranial aneurysm and subarachnoid hemorrhage clinical research:recommendations from the working group on long-term therapies[J]. Neurocritical Care, 2019, 30:79-86.
[16] Yu S, Oya S, Matsui T. Importance of determining the true etiology of bleeding:a case of left VA-PICA aneurysm with subarachnoid hemorrhage caused by another etiology confirmed during craniotomy[J]. No Shinkei Geka Neurological Surgery, 2017, 45(7):637.
[17] Pilipenko Y V, Konovalov A N, Eliava S S, et al. Reasonability and efficacy of decompressive craniectomy in patients with subarachnoid hemorrhage after microsurgical aneurysm exclusion[J]. Zhurnal Voprosy Neirokhirurgii Imeni N.n.burdenko, 2018, 82(1):59.
[18] Zador Z, Huang W, Sperrin M, et al. Multivariable and bayesian network analysis of outcome predictors in acute aneurysmal subarachnoid hemorrhage:review of a pure surgical series in the post-international subarachnoid aneurysm trial era[J]. Operative Neurosurgery, 2017, (6):6.
[19] Uysal E, Yanbulo lu B, Ertürk M, et al. Spiral CT angiography in diagnosis of cerebral aneurysms of cases with acute subarachnoid hemorrhage[J]. Diagnostic & Interventional Radiology, 11(2):77-82.
[20] Hashimoto H, Iida J, Hironaka Y, et al. Use of spiral computerized tomography angiography in patients with subarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms[J]. Journal of Neurosurgery, 92(2):278-283.