CAJ | 학술논문

目的：对比研究三维64层螺旋 CT 血管造影（3D-CTA）和三维数字减影血管造影（3D-DSA）诊断颅内动脉瘤（ AN）（尤其是直径<3 mm 的微小 AN）的价值，以及3D-CTA 与3D-DSA 不同技术之间的对颅内 AN 检出率的一致性分析。方法共有61例患者纳入本研究，其中女性23例，男性38例，平均年龄51岁；所有患者磁共振血管造影或临床表现提示颅内动脉瘤。所有患者行3D-DSA和3D-CTA。以3D-DSA为“金标准”，评估3D-CTA诊断颅内动脉瘤的准确性、特异性、灵敏度以及不同技术间的一致性。结果3D-DSA在53例患者中共检出61个AN病灶，其余8例未发现AN。3D-CTA检出AN 52个，准确性为92.9%~95.6%（均值93.8%），灵敏度为92.9%~93.9%（均值93.2%），特异性为82.9%~100.0%（均值91.2%）；对于AN病灶直径<3 mm，3D-CTA的灵敏度和特异性均值分别为85.5%和94.0%。对AN的检出，3D-CTA判读者之间及3D-CTA与3D-DSA不同技术之间一致性均为优-良（K=0.786~0.859，均值K=0.789）；对于AN瘤体最大径的测量，3D-CTA判读者之间及3D-CTA与3D-DSA间差异均无统计学意义（ P >0.05）。结论3D-64层螺旋CTA对AN灵敏度和特异性较高，与3D-DSA之间的一致性较高，可以作为疑似AN患者的首选筛查方法。两者联合可提高AN的检出率，为介入治疗AN提供可靠的影像学依据。
목적：대비연구삼유64층라선 CT 혈관조영（3D-CTA）화삼유수자감영혈관조영（3D-DSA）진단로내동맥류（ AN）（우기시직경<3 mm 적미소 AN）적개치，이급3D-CTA 여3D-DSA 불동기술지간적대로내 AN 검출솔적일치성분석。방법공유61례환자납입본연구，기중녀성23례，남성38례，평균년령51세；소유환자자공진혈관조영혹림상표현제시로내동맥류。소유환자행3D-DSA화3D-CTA。이3D-DSA위“금표준”，평고3D-CTA진단로내동맥류적준학성、특이성、령민도이급불동기술간적일치성。결과3D-DSA재53례환자중공검출61개AN병조，기여8례미발현AN。3D-CTA검출AN 52개，준학성위92.9%~95.6%（균치93.8%），령민도위92.9%~93.9%（균치93.2%），특이성위82.9%~100.0%（균치91.2%）；대우AN병조직경<3 mm，3D-CTA적령민도화특이성균치분별위85.5%화94.0%。대AN적검출，3D-CTA판독자지간급3D-CTA여3D-DSA불동기술지간일치성균위우-량（K=0.786~0.859，균치K=0.789）；대우AN류체최대경적측량，3D-CTA판독자지간급3D-CTA여3D-DSA간차이균무통계학의의（ P >0.05）。결론3D-64층라선CTA대AN령민도화특이성교고，여3D-DSA지간적일치성교고，가이작위의사AN환자적수선사사방법。량자연합가제고AN적검출솔，위개입치료AN제공가고적영상학의거。
Objective To compare digital subtraction angiography(DSA)and three-dimensional rotational angiography(3D-DSA) with 64-multislice 3D-CT angiography(CTA)in the detection and characterization of intracranial aneurysms(especially diameter <3 mm), and assess inter- technique and inter-observer reproducibility of 64 -multislice 3D-CTA for detection and evaluation of intracranial aneu-rysms. Methods From September 2011 to March 2013,a total of 56 consecutive patients with suspected aneurysm were enrolled,included 31 males and 25 females,who with a mean age of 51. All of the patients underwent both 3D-CTA and 3D-DSA. Two radiologists independently re-viewed CT images,and 2 other radiologists reviewed 3D-DSA images. Using 3D-DSA as the″gold standard″,the sensitivity,specificity,inter-technique and inter-observer reproducibility of 3D-CTA were assessed. Results The 3D-DSA revealed 61 aneurysms in 53 patients and non- aneurysm in 9. The 3D-CTA revealed 52 aneurysms,accuracy,mean sensitivity and specificity of 3D-CTA for the detection of intracra-nial aneurysms were 93. 8%(92. 9% ~95. 6%),93. 2%(92. 9% ~93. 9%)and 91. 2%(82. 9% ~100. 0%),respectively. For aneurysms <3 mm,CTA had the mean sensitivity of 85. 5% and specificity of 94. 0%. Inter -technique and inter -observer agreements were excellent for detection of aneurysms(K=0. 786~859 and K=0. 789,respectively). For the measurement of aneurysm diameters,the results showed no statis-tically significant difference( P >0. 05). Conclusion It is demonstrated that the 3D 64-multislice CTA is an imaging method with good inter-observer reproducibility and high sensitivity and specificity for the detection and morphologic evaluation of ruptured intracranial aneurysms( es-pecially diameter <3 mm). Combination of the 2 methods could improve the detection rate of aneurysm,and provide the reliable interventional ra-diological basis for aneurysm.