Binaghi S, Colleoni M L, Maeder P, Uské A, Regli L, Dehdashti A Reza, Schnyder P, Meuli R
Department of Diagnostic and Interventional Radiology, Neuroradiology Unit, University Hospital, Lausanne, Switzerland.
AJNR Am J Neuroradiol. 2007 Apr;28(4):750-8.
We investigated the association of multisection CT angiography (MSCTA) and perfusion CT (PCT) for the characterization of vasospasm secondary to aneurysmal subarachnoid hemorrhage.
Among 27 patients with symptomatic cerebrovascular vasospasm investigated by digital subtraction angiography (DSA), 18 underwent both cerebral PCT and MSCTA. For the remaining 9, only PCT or MSCTA could be performed. MSCTA was compared with DSA for the detection and characterization of vasospasm on 286 intracranial arterial segments. PCT maps were visually reviewed for mean transit time, relative cerebral blood flow, and relative cerebral blood volume abnormalities and were qualitatively compared with the corresponding regional vasospasm detected by DSA.
Vasospasm was grouped into 2 categories: mild-moderate and severe. The depiction of vasospasm by MSCTA showed the best sensitivity, specificity, and accuracy at the level of the A2 and M2 arterial segments (100% for each), in contrast to the carotid siphon (45%, 100%, and 85% respectively). The characterization of vasospasm severity by MSCTA showed a sensitivity, specificity, and accuracy of 86.8%, 96.8%, and 95.2%, respectively, for mild-moderate vasospasm, and 76.5%, 99.5%, and 97.5%, respectively, for severe vasospasm. The PCT abnormalities were related to severe vasospasm in 9 patients and to mild-to-moderate vasospasm in 2. The sensitivity, specificity, and accuracy of PCT in detecting vasospasm were 90%, 100%, and 92.3%, respectively, for severe vasospasm, and 20%, 100%, and 38.5%, respectively, for mild-moderate vasospasm.
MSCTA/PCT can assess the location and severity of cerebrovascular vasospasm and its related perfusion abnormalities. It can identify severe vasospasm with risk of delayed ischemia and can thus guide the invasive treatment.
我们研究了多层CT血管造影（MSCTA）和灌注CT（PCT）在动脉瘤性蛛网膜下腔出血继发血管痉挛特征描述方面的相关性。
在27例经数字减影血管造影（DSA）检查的有症状脑血管痉挛患者中，18例同时接受了脑PCT和MSCTA检查。其余9例仅进行了PCT或MSCTA检查。在286个颅内动脉节段上，将MSCTA与DSA用于血管痉挛的检测和特征描述进行比较。对PCT图进行视觉评估，观察平均通过时间、相对脑血流量和相对脑血容量异常情况，并与DSA检测到的相应区域血管痉挛进行定性比较。
血管痉挛分为2类：轻度-中度和重度。MSCTA对血管痉挛的显示在A2和M2动脉节段水平具有最佳的敏感性、特异性和准确性（各为100%），而在颈动脉虹吸部则分别为45%、100%和85%。MSCTA对血管痉挛严重程度的特征描述显示，对于轻度-中度血管痉挛，敏感性、特异性和准确性分别为86.8%、96.8%和95.2%，对于重度血管痉挛分别为76.5%、99.5%和97.5%。9例患者的PCT异常与重度血管痉挛相关，2例与轻度-中度血管痉挛相关。PCT检测血管痉挛的敏感性、特异性和准确性，对于重度血管痉挛分别为90%、100%和92.3%，对于轻度-中度血管痉挛分别为20%、100%和38.5%。
MSCTA/PCT可评估脑血管痉挛的位置和严重程度及其相关的灌注异常。它能识别有延迟缺血风险的重度血管痉挛，从而指导侵入性治疗。
