Head and neck CT angiography has higher diagnostic and value for intracranial aneurysms
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摘要:
目的 探究头颈部CT血管成像（CTA）在颅内动脉瘤中的诊断效果及在手术指导中的应用价值。 方法 选择2018年6月~ 2021年9月本院收治的129例颅内动脉瘤疑似患者纳入研究对象，均行头颈部CTA诊断和磁共振血管成像（MRA）诊断，以数字减影血管造影（DSA）作为金标准，比较头颈部CTA诊断和MRA诊断对颅内动脉瘤的诊断及手术应用价值。 结果 以DSA诊断为“金标准”，129例颅内动脉瘤疑似患者经DSA诊断证实有80例确诊为颅内动脉瘤，头颈部CTA诊断准确度为92.24%，敏感度为95.06%，特异性为87.50%，阳性预测值为92.77%，阴性预测值为91.30%；MRA诊断准确度为88.37%，敏感度为91.46%，特异性为82.97%，阳性预测值为90.36%，阴性预测值为84.78%。头颈部CTA诊断和MRA诊断的病灶检出部位差异无统计学意义（P>0.05）。头颈部CTA诊断检出 < 3 mm直径的瘤体数量多于MRA诊断（P < 0.05）。头颈部CTA诊断Kappa值为0.850，MRA诊断的Kappa值为0.747，头颈部CTA诊断与DSA诊断一致性更高。 结论 头颈部CT血管成像对颅内动脉瘤的诊断价值更高，对手术治疗具有更好的指导作用。 -
关键词:
- 电子计算机断层扫描血管成像 /
- 颅内动脉瘤 /
- 诊断价值 /
- 手术指导
Abstract:Objective To explore the diagnostic efficiency of head and neck computerized tomography angiography (CTA) for intracranial aneurysms and its application value in surgical guidance. Methods A total of 129 patients with suspected intracranial aneurysms admitted to the hospital were enrolled as the research objects from June 2018 to September 2021. All patients underwent head and neck CTA and magnetic resonance angiography (MRA). Taking digital subtraction angiography (DSA) as the golden standard, application value of head and neck CTA and MRA in the diagnosis and surgical guidance of intracranial aneurysms was compared. Results Taking DSA diagnosis as the golden standard, there were 80 cases confirmed with intracranial aneurysms in the 129 patients. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of head and neck CTA and MRA were 92.24%, 95.06%, 87.50%, 92.77%, 91.30% and 88.37%, 91.46%, 82.97%, 90.36%, 84.78%, respectively. There was no significant difference in detection sites of lesions between head and neck CTA and MRA (P > 0.05). The number of tumors with diameter < 3 mm by head and neck CTA was more than that by MRA (P < 0.05). The Kappa values of head and neck CTA and MRA were 0.850 and 0.747, respectively. The diagnosis consistency between head and neck CTA and DSA was higher. Conclusion The diagnostic value of head and neck CTA is higher for intracranial aneurysms, which is of better guidance roles in surgical treatment. -
图 1 颅内动脉瘤诊断图像
A~D: 病例1; E~H: 病例2.
Figure 1. Diagnostic images of intracranial aneurysms
表 1 头颈部CTA诊断诊断结果
Table 1. Diagnostic results of head and neck CTA (n)
DSA诊断 头颈部CTA诊断 MRA诊断 合计 阳性 阴性 阳性 阴性 阳性 77 6 75 8 83 阴性 4 42 7 39 46 合计 81 48 82 47 129 DSA: 数字减影血管造影; CTA: CT血管成像; MRA: 磁共振血管成像. 
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表 2 病灶检出部位比较
Table 2. Detection of lesion location [n(%)]
病灶检出部位 头颈部CTA诊断 MRA诊断 χ2/Fisher P 颈内动脉 12（15.00） 11（13.75） 0.025 0.875 大脑前动脉 9（11.25） 8（10.00） 0.040 0.842 前交通动脉 22（27.50） 22（27.50） 0.011 0.918 后交通动脉 18（22.50） 17（21.25） 0.013 0.927 大脑中动脉 4（5.00） 5（6.25） - 0.744 大脑后动脉 7（8.75） 7（8.75） 0.003 0.959 椎基底动脉 5（6.25） 5（6.25） 0.002 0.966 合计 77（96.25） 75（93.75） 0.526 0.468
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表 3 不同直径瘤体检出情况比较
Table 3. Detection of tumors of different diameters [n(%)]
瘤体直径（mm） 头颈部CTA诊断 MRA诊断 χ2/ Fisher P < 3（n=20） 18（90.00） 12（60.00） 4.801 0.028 3~5（n=27） 26（96.29） 24（92.30） 1.081 0.299 6~9（n=21） 20（95.23） 18（85.71） 1.105 0.293 > 9（n=12） 12（100.00） 12（100.00） - 1.000
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表 4 诊断价值比较
Table 4. Comparison of diagnostic value
诊断方法 准确度(%) 敏感度(%) 特异性(%) 阳性预测值(%) 阴性预测值(%) Kappa值 头颈部CTA诊断 93.02 96.25 87.75 92.77 93.47 0.850 MRA诊断 88.37 91.46 82.97 90.36 84.78 0.747 χ2 0.051 0.031 0.056 0.012 0.059 - P 0.821 0.861 0.812 0.912 0.808 -
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