自发性颅内出血患者的CT血管造影或数字减影血管造影:回顾性病例系列研究
자발성로내출혈환자적CT혈관조영혹수자감영혈관조영:회고성병례계렬연구
CT angiography or digital subtraction angiography in patients with spontaneous intracranial hemorrhage: a retrospective case series study
  • 万方数据
    国际脑血管病杂志 국제뇌혈관병잡지
    INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
    2013年 11期 827-831 ,共5页

    张丽萍%唐秉航%李良才%何亚奇%吴任国%李芳云%黄晖%黄德成%林乐

    장려평%당병항%리량재%하아기%오임국%리방운%황휘%황덕성%림악

    颅内出血%脑出血%蛛网膜下腔出血%颅内动脉瘤%颅内动静脉畸形%烟雾病%脑血管造影术%体层摄影术,X线计算机%血管造影术,数字减影 顱內齣血%腦齣血%蛛網膜下腔齣血%顱內動脈瘤%顱內動靜脈畸形%煙霧病%腦血管造影術%體層攝影術,X線計算機%血管造影術,數字減影
    로내출혈%뇌출혈%주망막하강출혈%로내동맥류%로내동정맥기형%연무병%뇌혈관조영술%체층섭영술,X선계산궤%혈관조영술,수자감영
    Intracranial Hemorrhages%Cerebral Hemorrhage%Subarachnoid Hemorrhage%Intracranial Aneurysm%Intracranial Arteriovenous Malformations%Moyamoya Disease%Cerebral Angiography%Tomography,X-Ray Computed%Angiography,Digital Subtraction
    目的 探讨脑血管造影,包括CT血管造影(CT angiography,CTA)或数字减影血管造影(digital subtraction angiography,DSA)在自发性颅内出血患者中的意义.方法 纳入自发性颅内出血患者,分析其人口统计学和影像学资料.根据血管造影结果分为阳性和阴性组,进一步分析自发性颅内出血的危险因素及其脑血管造影的意义.结果 共纳入343例自发性颅内出血患者,年龄6～95岁,平均(56.3±14.2)岁,78例(22.7％)≤45岁,265例(77.3％)＞45岁;男性208例(60.6％),女性135例(39.4％).在343例自发性颅内出血患者中,血管造影阳性117例(CTA或DSA任意一项阳性),其中脑动脉瘤75例(64.1％),脑血管畸形(包括动静脉畸形和动静脉瘘)22例(18.8％),烟雾病20例(17.1％);血管造影阴性(CTA和DSA均阴性)226例.血管造影阳性组平均年龄显著性小于血管造影阴性组[(52.45 ±14.33)岁对(58.25±13.58)岁;t=-3.679,P=0.000].血管造影阳性组≤45岁(46.15％对53.85％;x2=6.515,P=0.011)、男性(28.36％对71.63％;x2=7.762,P=0.005)、高血压(62.40％对83.20％;x2=18.321,P=0.000)、吸烟(15.40％对27.90％;x2=7.831,P=0.005)、饮酒(10.30％对21.20％;x2 =6.443,P=0.011)的患者构成比显著性低于血管造影阴性组.两组间出血部位存在显著性差异(X2=80.087,P=0.000),血管造影阳性组以蛛网膜下腔出血多见(49.60％),而血管造影阴性组以基底节出血(36.30％)多见.两组糖尿病(x2 =0.391,P=0.532)和高脂血症(X2=0.387,P=0.534)患者的构成比无显著性差异.多变量logistic回归分析显示,年龄[优势比(odds ratio,OR)1.035,95％可信区间(confidence interval,CI)1.015 ～1.056;P =0.001]和出血部位(OR0.690,95％ CI0.614 ～0.776;P =0.000)与血管造影阳性独立相关.对出血部位的分析显示,蛛网膜下腔出血的病因主要为脑动脉瘤(82.8％),其次为脑血管畸形(12.1％)和烟雾病(5.2％);脑室出血的病因主要为烟雾病(58.3％),其次为脑动脉瘤(33.3％).脑叶出血的病因主要为脑动脉瘤(50.0％)和脑血管畸形(45.0％).小脑出血的病因主要为脑血管畸形(60.0％)和脑动脉瘤(40.0％).蛛网膜下腔和脑室出血患者的血管造影阳性率分别为49.60％和10.30％,脑叶和小脑出血的血管造影阳性率分别为17.10％和4.30％,基底节和丘脑出血的血管造影阳性率分别为12.00％和5.10％,而脑干和多部位出血的血管造影阳性率极低(均为0.90％).在343例接受CTA检查的自发性颅内出血患者中,111例经DSA或手术证实,其中CTA误诊6例,漏诊6例.CTA诊断的准确率为89.2％,敏感性为93.6％,特异性为64.7％,阳性预测值为93.6％,阴性预测值为64.7％.结论 根据年龄和出血部位推测病因具有一定参考意义.在条件允许的情况下,所有自发性颅内出血患者均应行CTA检查.
    목적 탐토뇌혈관조영,포괄CT혈관조영(CT angiography,CTA)혹수자감영혈관조영(digital subtraction angiography,DSA)재자발성로내출혈환자중적의의.방법 납입자발성로내출혈환자,분석기인구통계학화영상학자료.근거혈관조영결과분위양성화음성조,진일보분석자발성로내출혈적위험인소급기뇌혈관조영적의의.결과 공납입343례자발성로내출혈환자,년령6～95세,평균(56.3±14.2)세,78례(22.7％)≤45세,265례(77.3％)＞45세;남성208례(60.6％),녀성135례(39.4％).재343례자발성로내출혈환자중,혈관조영양성117례(CTA혹DSA임의일항양성),기중뇌동맥류75례(64.1％),뇌혈관기형(포괄동정맥기형화동정맥루)22례(18.8％),연무병20례(17.1％);혈관조영음성(CTA화DSA균음성)226례.혈관조영양성조평균년령현저성소우혈관조영음성조[(52.45 ±14.33)세대(58.25±13.58)세;t=-3.679,P=0.000].혈관조영양성조≤45세(46.15％대53.85％;x2=6.515,P=0.011)、남성(28.36％대71.63％;x2=7.762,P=0.005)、고혈압(62.40％대83.20％;x2=18.321,P=0.000)、흡연(15.40％대27.90％;x2=7.831,P=0.005)、음주(10.30％대21.20％;x2 =6.443,P=0.011)적환자구성비현저성저우혈관조영음성조.량조간출혈부위존재현저성차이(X2=80.087,P=0.000),혈관조영양성조이주망막하강출혈다견(49.60％),이혈관조영음성조이기저절출혈(36.30％)다견.량조당뇨병(x2 =0.391,P=0.532)화고지혈증(X2=0.387,P=0.534)환자적구성비무현저성차이.다변량logistic회귀분석현시,년령[우세비(odds ratio,OR)1.035,95％가신구간(confidence interval,CI)1.015 ～1.056;P =0.001]화출혈부위(OR0.690,95％ CI0.614 ～0.776;P =0.000)여혈관조영양성독립상관.대출혈부위적분석현시,주망막하강출혈적병인주요위뇌동맥류(82.8％),기차위뇌혈관기형(12.1％)화연무병(5.2％);뇌실출혈적병인주요위연무병(58.3％),기차위뇌동맥류(33.3％).뇌협출혈적병인주요위뇌동맥류(50.0％)화뇌혈관기형(45.0％).소뇌출혈적병인주요위뇌혈관기형(60.0％)화뇌동맥류(40.0％).주망막하강화뇌실출혈환자적혈관조영양성솔분별위49.60％화10.30％,뇌협화소뇌출혈적혈관조영양성솔분별위17.10％화4.30％,기저절화구뇌출혈적혈관조영양성솔분별위12.00％화5.10％,이뇌간화다부위출혈적혈관조영양성솔겁저(균위0.90％).재343례접수CTA검사적자발성로내출혈환자중,111례경DSA혹수술증실,기중CTA오진6례,루진6례.CTA진단적준학솔위89.2％,민감성위93.6％,특이성위64.7％,양성예측치위93.6％,음성예측치위64.7％.결론 근거년령화출혈부위추측병인구유일정삼고의의.재조건윤허적정황하,소유자발성로내출혈환자균응행CTA검사.
    Objective To investigate the significance of cerebrovascular angiography,including CT angiography (CTA) or digital subtraction angiography (DSA) in patients with spontaneous intracranial hemorrhage.Methods Three hundred forty-three patients with spontaneous intracranial hemorrhage were enrolled in the study.Their demographic and imaging data were analyzed.According to the results of angiography,the patients were divided into either a positive group or a negative group.The risk factors for spontaneous intracranial hemorrhage and their significance of cerebral vascular angiography were further analyzed.Results A total of 343 patients with spontaneous intracranial hemorrhage were enrolled.Their ages were 6 to 95 years old (mean 56.3 ± 14.2 years),78 patients (22.7％) were ≤ 45 years,265 (77.3％)were ＞ 45 years,208 (60.6％) were males,and 135 (39.4％) were females.Of the 343 patients with spontaneous intracranial hemorrhage,117 were angiography positive (CTA or DSA),in which 75 had cerebral aneurysms (64.1％),22 (18.8％) had cerebral vascular malformations (including arteriovenous malformations and arteriovenous fistula),and 20 (17.1％) had moyamoya disease.The angiography of 226patients was negative (Both CTA and DSA were negative).The mean age of the angiography positive group was significantly lower than that of the angiography negative group (52.45 ± 14.33 years vs.58.25 ±13.58 years; t=-3.679,P=0.000).The proportions of the patients of ≤ 45 years (46.15％ vs.53.85 ％ ; x2 =6.515,P =0.011),males (28.36％ vs.71.63 ％ ; x2 =7.762,P =0.005),hypertension (62.40％ vs.83.20％ ;x2 =18.321,P =0.000),smoking (15.40％ vs.27.90％ ;x2 =7.831,P =0.005),alcohol consumption (10.30％ vs.21.20％ ;x2 =6.443,P =0.011) in the angiography positive group were significantly lower than those in the angiography negative group.There was significant difference in bleeding sites between the two groups (x2=80.087,P=0.000).Subarachnoid hemorrhage (49.60％) were common in the angiography positive group,while basal ganglia hemorrhage (36.30％) were common in the negative angiography group.There were no significant difference in the proportions of patients with diabetes (x2 =0.391,P =0.532) and hyperlipidemia (x2 =0.387,P =0.534) between the two groups.Multivariate logistic regression analysis showed that the age (odds ratio [OR] 1.035,95％ confidence interval [CI]1.015-1.056; P=0.001) and the bleeding site (OR 0.690,95％ CI 0.614-0.776; P=0.000) were independently correlated with the positive angiography.The analysis of the bleeding site showed that the cause of subarachnoid hemorrhage was mainly cerebral aneurysms (82.8％),followed by cerebral vascular malformations (12.1％) and moyamoya disease (5.2％).The cause of intraventricular hemorrhage was mainly moyamoya disease (58.3％),followed by cerebral aneurysms (33.3％).The cause of lobar hemorrhage was mainly cerebral aneurysms (50.0％) and cerebral vascular malformations (45.0％).The cause of cerebellar hemorrhage was mainly cerebral vascular malformations (60.0％) and cerebral aneurysms (40.0％).The positive rates of angiography in patients with subarachnoid hemorrhage and intraventricular hemorrhage were 49.60％ and 10.30％,respectively,the positive rates of angiography of lobe and cerebellar hemorrhage were 17.10％ and 4.30％,respectively,and the positive rates of angiography of basal ganglia and thalamic hemorrhage were 12.00％ and 5.10％,respectively,while the positive rates of angiography of brainstem and multi-site bleeding were very low (both 0.90％).Of the 343patients with spontaneous intracranial hemorrhage who received CTA examination,111 were confirmed by DSA or surgery,in which 6 were misdiagnosed by CTA and 6 were missed diagnosis.The accuracy rate of CTA diagnosis was 89.2％,sensitivity was 93.6％,specificity was 64.7％,positive predictive value was 93.6％,and negative predictive value was 64.7％.Conclusions According to the age and the bleeding site,speculating about the etiology has a certain reference value.Under conditions permit,all patients with spontaneous intracranial hemorrhage should undergo CTA examination.
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