CAJ | 학술논문

目的：探讨64层M SC T A诊断颅内动脉瘤使用低剂量对比剂的可行性。方法将108例自发性蛛网膜下腔出血患者随机分成两组行颅脑MSCTA。使用低剂量对比剂者为A组共54例，对比剂优维显用量0．6ml （370mgI／ml）／kg ；使用常规剂量对比剂者为B组共54例，对比剂优维显用量1．2ml（370mgI／ml）／kg。使用相同的CT图像后处理重建方法、图像评分和评价标准，以数字减影血管造影（DSA）及手术结果作为金标准，比较A组和B组MSCTA分别使用两种剂量对比剂在图像质量及其对动脉瘤诊断符合率的差别。结果 A组54例患者中31例发现动脉瘤35个，漏诊3个，检出率92．1％，B组54例患者中36例发现动脉瘤37个，漏诊4个，检出率90．3％，两组病例的敏感度、特异度及诊断准确度差异均无统计学意义（ P ＞0．05）。A组和B组动脉瘤测量的最大径均值分别为5．8mm和6．5mm ，均分别与DSA （手术）有良好的相关关系（ r ＝0．968，0．971，P ＜0．05）。在动脉腔内各测量点CT 值的比较，A组与B组间差异无统计学意义（ t＝2．978，P＞0．05）。按照图像质量评分和颅内静脉污染程度评分标准，A组与B组间两组分值的差异均有统计学意义（ P ＜0．05）。结论 MSCTA对颅内动脉瘤的检测低剂量对比剂具有与常规剂量相似的准确度，但颅内静脉污染发生率降低，适合颅内动脉瘤的初筛、术前及术后评估。
목적：탐토64층M SC T A진단로내동맥류사용저제량대비제적가행성。방법장108례자발성주망막하강출혈환자수궤분성량조행로뇌MSCTA。사용저제량대비제자위A조공54례，대비제우유현용량0．6ml （370mgI／ml）／kg ；사용상규제량대비제자위B조공54례，대비제우유현용량1．2ml（370mgI／ml）／kg。사용상동적CT도상후처리중건방법、도상평분화평개표준，이수자감영혈관조영（DSA）급수술결과작위금표준，비교A조화B조MSCTA분별사용량충제량대비제재도상질량급기대동맥류진단부합솔적차별。결과 A조54례환자중31례발현동맥류35개，루진3개，검출솔92．1％，B조54례환자중36례발현동맥류37개，루진4개，검출솔90．3％，량조병례적민감도、특이도급진단준학도차이균무통계학의의（ P ＞0．05）。A조화B조동맥류측량적최대경균치분별위5．8mm화6．5mm ，균분별여DSA （수술）유량호적상관관계（ r ＝0．968，0．971，P ＜0．05）。재동맥강내각측량점CT 치적비교，A조여B조간차이무통계학의의（ t＝2．978，P＞0．05）。안조도상질량평분화로내정맥오염정도평분표준，A조여B조간량조분치적차이균유통계학의의（ P ＜0．05）。결론 MSCTA대로내동맥류적검측저제량대비제구유여상규제량상사적준학도，단로내정맥오염발생솔강저，괄합로내동맥류적초사、술전급술후평고。
Objective To evaluate 64 slices MSCTA with low dose contrast agent in diagnosis of intracranial aneurysms . Methods 108 cases with spontaneous subarachnoid hemorrhage were randomly divided into two groups in which odd num‐bers were set in group A and even number in group B .Brain MSCTA were taken on 54 cases of group A with low dose contrast medium using 0 .6 ml (370 mgI/ml)/kg and 54 cases of group B with routine dose contrast medium using 0 .6 ml (370 mgI/ml)/kg .Both group A and B underwent the same CT imaging reconstruction and the same imaging evaluation . Reference in DSA or operation data ,two doses of contrast agents in group A and B ,MSCTA image quality and the diagno‐sis of intracranial aneurysm compliance rates were compared statistically .Results Thirty‐one in 54 cases of group A were found intracranial aneurysms in 35(92 .1% ) ,and missed in 3 .Thirty‐six in 54 cases of group B were found intracranial an‐eurysms in 37(90 .3% ) ,and missed in 4 .The differences of sensitivity ,specificity and accuracy of MSCTA between group A and B were no statistically significant ( P >0 .05) .The biggest diameter of aneurysms in group A and B were 5 .8 mm and 6 .5 mm ,and correlated to DSA or operation data perfectly ( r =0 .968 and 0 .971 ,P<0 .05) .The differences of CT value within artery between group A and B were no statistically significant ( t=2 .978 ,P>0 .05) .The difference of ima‐ging quality and vein pollution evaluation between group A and B were statistically significant ( P <0 .05) .Conclusion The accuracy of low‐dose contrast medium MSCTA in detection of intracranial aneurysms was similar to conventional‐dose contrast medium ,but low‐dose contrast medium MSCTA was less vein pollution ,and therefore being suitable for intracra‐nial aneurysm primary checking ,preoperative and postoperative evaluation .