中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
2期
191-198
,共8页
刘军%王霞%王兆华%王浩洲%李庆民
劉軍%王霞%王兆華%王浩洲%李慶民
류군%왕하%왕조화%왕호주%리경민
颈内动脉瘤%体层摄影术,螺旋计算机%血管造影术,数字减影
頸內動脈瘤%體層攝影術,螺鏇計算機%血管造影術,數字減影
경내동맥류%체층섭영술,라선계산궤%혈관조영술,수자감영
Carotid artery diseases%Tomography,spiral computed%Digital subtraction angiography
目的：探讨多层螺旋CT（multiple-slice spiral computed tomography angiography， MSCTA）和三维DSA（three-dimensional digital subtraction angiography，3D-DSA）重建成像在颈内动脉瘤构型分析中的意义，对比其在颈内动脉瘤诊断与治疗中的价值。方法回顾性分析91例可疑颅内动脉瘤患者的临床和影像资料，全部行MSCTA和3D-DSA检查，其重建成像显示颈内动脉瘤的三维空间构型，比较研究颈内动脉瘤的位置、形态、颈内动脉瘤瘤颈开口与载瘤动脉的连接方式、动脉瘤与颈内动脉及其分支血管开口的相互空间结构关系。并以3D-DSA重建成像结果为标准，计算MSCTA重建成像对诊断颈内动脉瘤的敏感性、特异性及准确度；采用Kappa分析评价MSCTA重建成像与3D-DSA重建成像两种诊断方法显示颈内动脉瘤的一致性；采用卡方检验分析检验MSCTA重建成像与3D-DSA重建成像两种诊断方法显示双泡及多泡型颈内动脉瘤的阳性率。结果3D-DSA重建成像证实为颈内动脉瘤78例，其中单发59例，多发19例，共发现108枚动脉瘤；所有颈内动脉瘤可分型为三类：（1）单泡型动脉瘤74枚（68.52%）。（2）双泡及多泡型动脉瘤33枚（30.56%）。（3）梭型动脉瘤1枚（0.93%）。MSCTA重建成像检出颈内动脉瘤77例，单发58例，多发19例，共发现106枚动脉瘤；其中单泡型86枚（81.13%），双泡及多泡型19枚（17.92%），梭形动脉瘤1枚（0.94%）；两者检查均为阴性13例。从另一个角度分析，所有颈内动脉瘤根据3D-DSA重建成像还可分型为：颈内动脉分支开口无关型动脉瘤、颈内动脉分支开口相关型动脉瘤和分支泡上发出型动脉瘤，分别有52枚、37枚和19枚；MSCTA重建成像显示的以上各型颈内动脉瘤分别是51枚、36枚和19枚；以3D-DSA重建成像为标准，MSCTA重建成像诊断颈内动脉瘤的敏感性、特异性、准确度分别为98.14%、92.86%、97.54%，两种检查方法有较强的一致性（Kappa＝0.883， P＜0.05）。3D-DSA重建成像显示双泡及多泡型颈内动脉瘤的阳性率为30.56%（33/108），高于MSCTA重建成像显示的阳性率17.92%（19/106），差异具有统计学意义（χ2＝7.25，P＜0.01）。结论 MSCTA重建成像为诊断颈内动脉瘤提供一个可靠的筛选、早期诊断的手段；而3D-DSA重建成像则清晰显示颈内动脉瘤的结构形态、动脉瘤与颈内动脉及其分支开口的空间结构关系，为制定合理的治疗方案提供了必要的可靠依据。
目的：探討多層螺鏇CT（multiple-slice spiral computed tomography angiography， MSCTA）和三維DSA（three-dimensional digital subtraction angiography，3D-DSA）重建成像在頸內動脈瘤構型分析中的意義，對比其在頸內動脈瘤診斷與治療中的價值。方法迴顧性分析91例可疑顱內動脈瘤患者的臨床和影像資料，全部行MSCTA和3D-DSA檢查，其重建成像顯示頸內動脈瘤的三維空間構型，比較研究頸內動脈瘤的位置、形態、頸內動脈瘤瘤頸開口與載瘤動脈的連接方式、動脈瘤與頸內動脈及其分支血管開口的相互空間結構關繫。併以3D-DSA重建成像結果為標準，計算MSCTA重建成像對診斷頸內動脈瘤的敏感性、特異性及準確度；採用Kappa分析評價MSCTA重建成像與3D-DSA重建成像兩種診斷方法顯示頸內動脈瘤的一緻性；採用卡方檢驗分析檢驗MSCTA重建成像與3D-DSA重建成像兩種診斷方法顯示雙泡及多泡型頸內動脈瘤的暘性率。結果3D-DSA重建成像證實為頸內動脈瘤78例，其中單髮59例，多髮19例，共髮現108枚動脈瘤；所有頸內動脈瘤可分型為三類：（1）單泡型動脈瘤74枚（68.52%）。（2）雙泡及多泡型動脈瘤33枚（30.56%）。（3）梭型動脈瘤1枚（0.93%）。MSCTA重建成像檢齣頸內動脈瘤77例，單髮58例，多髮19例，共髮現106枚動脈瘤；其中單泡型86枚（81.13%），雙泡及多泡型19枚（17.92%），梭形動脈瘤1枚（0.94%）；兩者檢查均為陰性13例。從另一箇角度分析，所有頸內動脈瘤根據3D-DSA重建成像還可分型為：頸內動脈分支開口無關型動脈瘤、頸內動脈分支開口相關型動脈瘤和分支泡上髮齣型動脈瘤，分彆有52枚、37枚和19枚；MSCTA重建成像顯示的以上各型頸內動脈瘤分彆是51枚、36枚和19枚；以3D-DSA重建成像為標準，MSCTA重建成像診斷頸內動脈瘤的敏感性、特異性、準確度分彆為98.14%、92.86%、97.54%，兩種檢查方法有較彊的一緻性（Kappa＝0.883， P＜0.05）。3D-DSA重建成像顯示雙泡及多泡型頸內動脈瘤的暘性率為30.56%（33/108），高于MSCTA重建成像顯示的暘性率17.92%（19/106），差異具有統計學意義（χ2＝7.25，P＜0.01）。結論 MSCTA重建成像為診斷頸內動脈瘤提供一箇可靠的篩選、早期診斷的手段；而3D-DSA重建成像則清晰顯示頸內動脈瘤的結構形態、動脈瘤與頸內動脈及其分支開口的空間結構關繫，為製定閤理的治療方案提供瞭必要的可靠依據。
목적：탐토다층라선CT（multiple-slice spiral computed tomography angiography， MSCTA）화삼유DSA（three-dimensional digital subtraction angiography，3D-DSA）중건성상재경내동맥류구형분석중적의의，대비기재경내동맥류진단여치료중적개치。방법회고성분석91례가의로내동맥류환자적림상화영상자료，전부행MSCTA화3D-DSA검사，기중건성상현시경내동맥류적삼유공간구형，비교연구경내동맥류적위치、형태、경내동맥류류경개구여재류동맥적련접방식、동맥류여경내동맥급기분지혈관개구적상호공간결구관계。병이3D-DSA중건성상결과위표준，계산MSCTA중건성상대진단경내동맥류적민감성、특이성급준학도；채용Kappa분석평개MSCTA중건성상여3D-DSA중건성상량충진단방법현시경내동맥류적일치성；채용잡방검험분석검험MSCTA중건성상여3D-DSA중건성상량충진단방법현시쌍포급다포형경내동맥류적양성솔。결과3D-DSA중건성상증실위경내동맥류78례，기중단발59례，다발19례，공발현108매동맥류；소유경내동맥류가분형위삼류：（1）단포형동맥류74매（68.52%）。（2）쌍포급다포형동맥류33매（30.56%）。（3）사형동맥류1매（0.93%）。MSCTA중건성상검출경내동맥류77례，단발58례，다발19례，공발현106매동맥류；기중단포형86매（81.13%），쌍포급다포형19매（17.92%），사형동맥류1매（0.94%）；량자검사균위음성13례。종령일개각도분석，소유경내동맥류근거3D-DSA중건성상환가분형위：경내동맥분지개구무관형동맥류、경내동맥분지개구상관형동맥류화분지포상발출형동맥류，분별유52매、37매화19매；MSCTA중건성상현시적이상각형경내동맥류분별시51매、36매화19매；이3D-DSA중건성상위표준，MSCTA중건성상진단경내동맥류적민감성、특이성、준학도분별위98.14%、92.86%、97.54%，량충검사방법유교강적일치성（Kappa＝0.883， P＜0.05）。3D-DSA중건성상현시쌍포급다포형경내동맥류적양성솔위30.56%（33/108），고우MSCTA중건성상현시적양성솔17.92%（19/106），차이구유통계학의의（χ2＝7.25，P＜0.01）。결론 MSCTA중건성상위진단경내동맥류제공일개가고적사선、조기진단적수단；이3D-DSA중건성상칙청석현시경내동맥류적결구형태、동맥류여경내동맥급기분지개구적공간결구관계，위제정합리적치료방안제공료필요적가고의거。
Objective To investigate the diagnosis and treatment values of MSCTA and 3D-DSA reconstruction imaging in the internal carotid artery aneurysm patients. Methods A retrospective analysis of 91 patients with the clinical data and imaging data of suspected intracranial aneurysms. All patients were underwent MSCTA and 3D-DSA examination. It was mainly show the three-dimensional conformation of the internal carotid artery aneurysm, mainly study of the location and shape of the carotid artery aneurysms and the connecting mode of internal carotid aneurysm neck opening with the parent artery and the classification of the internal carotid artery aneurysm. Study the sensitivity, specificity and accuracy of MSCTA in the diagnosis of carotid artery aneurysms using 3D-DSA as standard and the consistency of MSCTA reconstruction and 3D-DSA reconstruction using Kappa analysis. Study the positive rate of MSCTA and 3D-DSA in the diagnosis of double bubble and foam type internal carotid artery aneurysm using the chi-squared test analysis. Results Using 3D-DSA reconstruction 78 patients were found with internal carotid artery aneurysms, in which the single bubble patients were 59 cases, multiple bubble patients were 19 cases, 108 internal carotid artery aneurysm were found; the internal carotid artery aneurysm can be divided into three categories:(1) Single bubble type aneurysm were 74 cases accounting for 68.52%. (2) Double bubble and foam type aneurysm were 19 cases accounting for 17.92%. (3) Shuttle type aneurysm was 1 case, accounting for 0.93%. Using MSCTA reconstruction 77 patients with internal carotid artery aneurysms were detected, the solitary cases were 58, multiple cases were 19, 106 internal carotid artery aneurysms were found, in which the single bubble type were 86 cases, double bubble and foam type were 19 cases, aortic dissecting aneurysm was 1 case. From another perspective, according to 3D-DSA reconstruction all internal carotid artery aneurysm can be divided into carotid artery branch opening independent aneurysm, carotid artery branch opening related aneurysm and branch bubble from aneurysm, there were 52, 37 and 19 cases respectively;there were 51, 36 and 19 respectively according to MSCTA reconstruction;Taking 3D-DSA reconstruction as the standard, The sensitivity, specificity, accuracy of MSCTA reconstruction imaging in the diagnosis of internal carotid artery aneurysm of is 98.14%, 92.86%, 97.54%respectively. The strong consistency of two methods was observed(Kappa=0.883, P<0.05) The positive rate of 3D-DSA reconstruction imaging revealing double bubble and foam type internal carotid artery aneurysm was 30.56% (33/78).It was higher than that of MSCTA reconstruction imaging (17.92%, 19/77), the difference was statistically significant (χ2=7.25, P<0.01). Conclusions MSCTA reconstruction imaging is reliable for screening and early diagnosis of internal carotid artery aneurysms;and 3D-DSA reconstruction imaging can reveal the type of the internal carotid artery aneurysm and the space structure relationship of the parent artery and its branches opening ICA. It is providing necessary basis for the reasonable treatment.
