CAJ | 학술논문

目的评估颞骨CT血管造影(CTA)对搏动性耳鸣(PT)患者中硬脑膜动静脉瘘(DAVFs)检出的敏感性和特异性.方法分析2008-2012年首都医科大学附属北京同仁医院因PT入院,同时行颞骨CTA及数字血管造影(DSA)检查的患者资料.纳入经DSA诊断DAVFs的患者9例；同时纳入性别、年龄匹配但DSA未显示DAVFs的患者9例.由2位放射科医师在不知结果的情况下,评估以下征象的发生情况:颈外动脉分支不对称增粗、颈内静脉早显、颅底静脉丛不对称增多、静脉窦表面毛糙散乱、海绵窦提前显影、静脉窦狭窄、脑内皮质静脉不对称增粗、颞枕骨骨穿支不对称增多、棘孔不对称扩大.结果颈外动脉分支增粗的敏感性78％、特异性100％；颈内静脉早显的敏感性89％、特异性100％；颅底静脉丛不对称增多的敏感性89％、特异性89％；静脉窦表面毛糙散乱及颞枕骨骨穿支增多的敏感性均67％、特异性均为100％；海绵窦不对称显影的敏感性22％、特异性100％；静脉窦狭窄的敏感性33％、特异性78％；棘孔扩大的敏感性56％、特异性89％.脑内皮质静脉增粗均未见显示.结论 CTA可用于对PT患者中DAVFs的筛查性诊断,其中颅底静脉丛增多、颈内静脉早显、颈外动脉分支增粗、静脉窦表面毛糙散乱、颞枕骨骨穿支增多具有较高的敏感性和特异性.颈外动脉分支增粗提示该分支为DAVFs的供血动脉.此外,颞枕骨骨穿支增多和棘孔增宽可应用于平扫CT上对该病的评估.
목적 평고섭골CT혈관조영(CTA)대박동성이명(PT)환자중경뇌막동정맥루(DAVFs)검출적민감성화특이성.방법 분석2008-2012년수도의과대학부속북경동인의원인PT입원,동시행섭골CTA급수자혈관조영(DSA)검사적환자자료.납입경DSA진단DAVFs적환자9례；동시납입성별、년령필배단DSA미현시DAVFs적환자9례.유2위방사과의사재불지결과적정황하,평고이하정상적발생정황:경외동맥분지불대칭증조、경내정맥조현、로저정맥총불대칭증다、정맥두표면모조산란、해면두제전현영、정맥두협착、뇌내피질정맥불대칭증조、섭침골골천지불대칭증다、극공불대칭확대.결과 경외동맥분지증조적민감성78％、특이성100％；경내정맥조현적민감성89％、특이성100％；로저정맥총불대칭증다적민감성89％、특이성89％；정맥두표면모조산란급섭침골골천지증다적민감성균67％、특이성균위100％；해면두불대칭현영적민감성22％、특이성100％；정맥두협착적민감성33％、특이성78％；극공확대적민감성56％、특이성89％.뇌내피질정맥증조균미견현시.결론 CTA가용우대PT환자중DAVFs적사사성진단,기중로저정맥총증다、경내정맥조현、경외동맥분지증조、정맥두표면모조산란、섭침골골천지증다구유교고적민감성화특이성.경외동맥분지증조제시해분지위DAVFs적공혈동맥.차외,섭침골골천지증다화극공증관가응용우평소CT상대해병적평고.
Objective To evaluate the sensitivity and specificity of computed tomographic angiography (CTA) for dural arteriovenous fistulas (DAVFs) in patients presenting with pulsatile tinnitus (PT).Methods The clinical and imaging data were collected for all patients undergoing CTA for PT from 2008 to 2012.Nine PT patients with DAVFs confirmed by digital subtraction angiography (DSA) and 9 ageand gender-matched control PT patients without DAVFs were selected.The CTA images were blindly analyzed by two experienced neuroradiologists for the following signs:asymmetric venous collaterals in extracranial space,asymmetric attenuation of internal jugular vein (IJV),asymmetric external carotid artery (ECA) branches,"shaggy" appearance of dural venous sinus,multiple transcalvarial channels,enlarged foramen spinosum,asymmetric cavernous sinus and enlarged cortical veins.Results The sensitivities of the following DAVFs signs were quite different:asymmetric attenuation of IJV (89％),asymmetric venous collaterals (89％),asymmetric ECA branches (78％),shaggy dural venous sinus (67％),multiple transcalvarial channels (67％),enlarged foramen spinosum (56％),stenosis of venous sinus (33％) and asymmetric cavernous sinus (2 2 ％).The presence of asymmetric attenuation of IJV,asymmetric ECA branches,shaggy dural venous sinus,multiple transcalvarial channels and asymmetric cavernous sinus all demonstrated a highly specificity of 100％ while the presence of asymmetric venous collaterals and enlarged foramen spinosum had a specificity of 89％.The presence of stenosis of venous sinus revealed a specificity of 78％.Enlarged cortical veins were all absent.Conclusion CTA may be used as a screening examination for DAVFs in PT patients.The presence of asymmetric venous collaterals,asymmetric attenuation of IJV,asymmetric ECA branches,shaggy dural venous sinus and multiple transcalvarial channels has a high sensitivity and specificity for diagnosis.Enlarged ECA branches usually serve as DAVFs feeders.Meanwhile,DAVF should be considered in PT patients when multiple transcalvarial channels and enlarged foramen spinosum are detected on high-resolution CT of temporal bone.