双源CT双能量技术在颅内动脉瘤诊断中的初步探讨

发布时间：2018-03-18 16:23

  本文选题：颅内动脉瘤　切入点：双源CT血管造影　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景和目的本研究评价第二代双源双能量CT(dual energy computed tomography,DECT)在CT血管造影(computed tomographic angiography,CTA)诊断颅内动脉瘤的作用及其应用价值,并与DSA进行对比,探索更准确、更合理的检查方法,为该病的临床治疗提供有价值的信息。资料和方法对我院2013年6月~2015年6月收治的经诊断疑似为颅内动脉瘤的受检者86例进行DE-CTA及DSA检查,年龄32~75岁,平均年龄(54.2±3.5)岁,其中男性36例,女性50例。患者主要有蛛网膜下腔出血(55例,占56.98%)、突发性头痛(45例,占46.51%)、脑出血(24例,占22.09%)、一侧动眼神经出血麻痹(16例,占12.79%)等表现,并排除有碘剂过敏史、有严重心功能不全及严重的肝肾功能不良情况,所有患者均征得同意并签署知情同意书。入院后均进行Hunt-Hess评分:0级:6例,Ⅰ级8例,Ⅱ级46例,Ⅲ级22例,Ⅳ级4例。对所有病例均行双源CT脑血管造影检查和DSA检查,以DSA检查结果为评价金标准,计算DE-CTA诊断颅内动脉瘤的敏感性、特异性、阳性预测值和阴性预测值,对比两种检查方法对动脉瘤的检出率;比较DE-CTA和DSA对不同大小的瘤体检出情况和瘤体直径测量情况;以及对比DE-CTA和DSA对动脉瘤瘤颈的显示清晰度。结果1.动脉瘤诊断情况:以DSA为对照标准,86病例中确诊72例,发现82个动脉瘤,14例为阴性患者,DE-CTA发现66例,74个动脉瘤,漏诊6例8个动脉瘤,假阳性2例。两种检查手段对颅内动脉瘤的检出率比较差异无统计学意义(P0.05)。2.诊断效能:以DSA诊断结果为对照标准,DE-CTA诊断颅内动脉瘤的敏感性为91.6%,特异性为85.7%,阳性预测值为97.0%,阴性预测值为66.7%。以动脉瘤数目计算,DE-CTA诊断动脉瘤的敏感性为90.2%,其中对于3mm的微小动脉瘤,其诊断敏感性为85.7%,3mm的动脉瘤(包括3~5mm的小型动脉瘤和体积更大的动脉瘤)其诊断敏感性为95.0%。3.瘤体直径测量结果比较:DSA测量瘤体直径为(5.4±2.3)mm,DE-CTA的测量结果为(5.5±1.8)mm,两种测量方法所测得的瘤体直径比较差异无统计学意义(P0.05)。CTA(VR)所显示动脉瘤图像不清晰8例,显示较清晰12个,显示清晰54个。DSA无显示不清晰病例,显示较清晰12个,显示清晰62个,秩和检验结果显示两种检查手段比较差异有统计学意义(P0.05)。结论1.DE-CTA对诊断颅内动脉瘤的敏感性和特异性较高,可作为DSA的替代手段用于对颅内动脉瘤的术前诊断;并且在动脉瘤定量测量与DSA结果具有很高的相关性,虽然DE-CTA对微小动脉瘤的有一定的漏诊率,总的来说仍有较高的应用价值,可以作为疑似颅内动脉瘤患者的首选筛查方法;2.DE-CTA双能量技术仅需进行一次增强扫描,便可获得多组不同数据图像,将其进行能量去骨减影和后处理重建,操作简单快速、创伤性小、成功率高,成为一种临床有效检查动脉瘤的影像学方法;3.DSA对于动脉瘤瘤颈及载瘤动脉的显示清晰度明显优于DE-CTA,对于后者未能清晰显示的应进一步接受DSA检查。
[Abstract]:Background and objective to evaluate the value of the second generation dual-energy CT(dual energy computed tomographygraphy (DECT) in the diagnosis of intracranial aneurysms by CT angiography and computed tomographic angiography (DSA), and to explore more accurate and reasonable methods for the diagnosis of intracranial aneurysms. Data and methods 86 patients suspected of intracranial aneurysm were examined by DE-CTA and DSA from June 2013 to June 2015. The average age was 54.2 卤3.5 years. Among them, 36 cases were males and 50 cases were females. There were 55 cases of subarachnoid hemorrhage (56.98%), 45 cases of sudden headache (46.51%), 24 cases of cerebral hemorrhage (22.09%), 16 cases of unilateral oculomotor hemorrhage paralysis (12.79%), and the exclusion of iodine hypersensitivity. There were severe cardiac insufficiency and severe hepatic and renal dysfunction. All the patients obtained consent and signed informed consent. After admission, Hunt-Hess score was given to 6 cases of grade 0: 6, 8 cases of grade 鈪，

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