Yoon D Y, Choi C S, Kim K H, Cho B-M
Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Gil-dong Kangdong-Gu, Seoul, Korea.
AJNR Am J Neuroradiol. 2006 Feb;27(2):370-7.
Cerebral vasospasm remains a major problem in patients recovering after surgical treatment of cerebral aneurysms. The purpose of this study was to evaluate cerebral vasospasm at multidetector-row spiral CT angiography (MDCTA) compared with digital subtraction angiography (DSA) in patients with aneurysmal subarachnoid hemorrhages (SAHs).
Seventeen patients suspected of having vasospasm on clinical findings underwent both postoperative MDCTA and DSA. MDCTA was analyzed by using volume-rendered images as well as axial images. A total of 251 arterial segments were analyzed for vasospasm by using a 5-point grading system. The MDCTA results were then compared with findings on the corresponding DSA images. Sensitivity, specificity, and accuracy of MDCTA for detection of hemodynamically significant spasms were also calculated, with findings at DSA used as the reference standard.
On DSA, 74 spasmatic segments were found among the 251 segments evaluated, and 40 segments with hemodynamically significant vasospasms were present. The overall agreement between MDCTA and DSA was 95.2%. We had 12 (4.8%) cases of disagreement between MDCTA and DSA. In 11 segments, the degree of stenosis was overestimated at MDCTA. Overall accuracy, sensitivity and specificity of MDCTA in the detection of hemodynamically significant vasospasm were 97.5%, 98.1%, and 98.0%, respectively, with positive and negative predictive values of 90.7% and 99.5%.
MDCTA appears to be a reliable alternative imaging technique to DSA in the assessment of patients with cerebral vasospasm after aneurysmal SAH.
在脑动脉瘤手术治疗后的患者中,脑血管痉挛仍然是一个主要问题。本研究的目的是在患有动脉瘤性蛛网膜下腔出血(SAH)的患者中,对比多排螺旋CT血管造影(MDCTA)与数字减影血管造影(DSA)评估脑血管痉挛的情况。
17例临床怀疑有血管痉挛的患者接受了术后MDCTA和DSA检查。通过容积再现图像以及轴位图像分析MDCTA。使用5分分级系统对总共251个动脉节段进行血管痉挛分析。然后将MDCTA结果与相应DSA图像的结果进行比较。以DSA检查结果作为参考标准,计算MDCTA检测血流动力学显著痉挛的敏感性、特异性和准确性。
在DSA检查中,在评估的251个节段中发现74个痉挛节段,有40个节段存在血流动力学显著的血管痉挛。MDCTA与DSA的总体一致性为95.2%。MDCTA与DSA有12例(4.8%)不一致。在11个节段中,MDCTA高估了狭窄程度。MDCTA检测血流动力学显著血管痉挛的总体准确性、敏感性和特异性分别为97.5%、98.1%和98.0%,阳性预测值和阴性预测值分别为90.7%和99.5%。
在评估动脉瘤性SAH后脑血管痉挛的患者时,MDCTA似乎是一种可靠的替代DSA的成像技术。