Hekali P, Kajander H, Pajari R, Stenman S, Somer T
Department of Diagnostic Radiology, Helsinki University Central Hospital, Finland.
Acta Radiol. 1991 Mar;32(2):143-8.
During a 10-year period, intraparenchymal aneurysms were found in 38 of 748 patients at selective abdominal angiography with magnification technique. According to strict criteria, 17 patients were classified as suffering from necrotizing vasculitis of the polyarteritis nodosa group (PAN), 7 from severe arterial hypertension, and 3 from rheumatoid arthritis. The diagnoses of 5 patients remained to be confirmed, and each of the remaining 6 patients suffered from various other diseases. PAN was diagnosed histopathologically in 2 patients without angiographic aneurysms. Based on the 156 patients in whom the indication for angiography was suspicion of arteritis, the angiographic diagnosis of PAN had a sensitivity of 89 percent and a specificity of 90 percent, a positive predictive value of 55 percent and a negative predictive value of 98 percent. The mean number of both renal and hepatic aneurysms was higher in patients with PAN than in the other patients (p less than 0.01 and p less than 0.05, respectively). Five PAN patients had numerous and large aneurysms, whereas the aneurysms of the other 12 PAN patients did not differ from those of patients with other diseases. Patients with PAN had renal infarcts more often than the other patients (p less than 0.05). Our findings suggest that visceral angiography is useful in establishing the diagnosis of PAN, but the angiographic finding of aneurysms is not pathognomonic.
在10年期间，748例患者接受选择性腹部血管造影放大技术检查，其中38例发现脑实质内动脉瘤。根据严格标准，17例患者被归类为结节性多动脉炎组（PAN）的坏死性血管炎患者，7例为重度动脉高血压患者，3例为类风湿关节炎患者。5例患者的诊断有待确认，其余6例患者各患其他多种疾病。2例无血管造影动脉瘤的患者经组织病理学诊断为PAN。基于156例血管造影指征为怀疑动脉炎的患者，PAN的血管造影诊断敏感性为89%，特异性为90%，阳性预测值为55%，阴性预测值为98%。PAN患者的肾动脉瘤和肝动脉瘤平均数量均高于其他患者（分别为p<0.01和p<0.05）。5例PAN患者有大量且较大的动脉瘤，而其他12例PAN患者的动脉瘤与其他疾病患者的动脉瘤无差异。PAN患者发生肾梗死的频率高于其他患者（p<0.05）。我们的研究结果表明，内脏血管造影有助于PAN的诊断，但动脉瘤的血管造影表现并非特异性的。
