Taschner C-A, Thines L, Lernout M, Lejeune J-P, Leclerc X
Department of neuroradiology, hôpital Roger-Salengro, CHRU Lille, University Hospital Lille, France.
J Neuroradiol. 2007 Oct;34(4):243-9. doi: 10.1016/j.neurad.2007.07.006. Epub 2007 Aug 29.
The aim of this study was to determine the accuracy of multi-detector row computed tomography angiography (CTA) for the triage of patients with acutely ruptured aneurysms, and to assess how therapeutic decisions based on this method compared with digital subtraction angiography (DSA).
Twenty-seven consecutive patients with acute subarachnoid hemorrhage were included, and underwent both CTA and DSA. CTA was performed on a 16-detector row CT scanner with a 0.75-mm collimation and a 0.558-beam pitch. Two readers reviewed the CTA data, and two different readers reviewed the DSA data. Aneurysm characteristics were recorded and treatment by surgical clipping or endovascular coil embolization was proposed.
A total of 24 aneurysms were identified on DSA in 21 patients. Sensitivity and specificity for CTA were 100% and 83%, respectively, on a per-aneurysm-basis. The correlation between DSA and CTA for the determination of sac and neck sizes was very good (r=0.92, and r=0.95, respectively, P<0.0001). Sensitivity and specificity for the detection of arterial branches incorporated into the aneurysmal sac or neck were 50% and 100%, respectively. In three aneurysms, readers judged CTA inappropriate for triage, because peri-aneurysmal branches were not properly visualized. Overall agreement between CTA and DSA regarding the therapeutic decision between surgical clipping and endovascular coil embolization in 24 aneurysms was good (kappa=0.76).
Multi-detector row CTA provides accurate anatomic information for aneurysm location as well as sac and neck sizes; however, the technique appears to have a low sensitivity in detecting branches incorporated into the aneurysmal sac.
本研究旨在确定多排螺旋计算机断层血管造影（CTA）对急性破裂动脉瘤患者进行分诊的准确性，并评估基于该方法做出的治疗决策与数字减影血管造影（DSA）相比如何。
纳入27例连续的急性蛛网膜下腔出血患者，均接受CTA和DSA检查。CTA采用16排CT扫描仪进行，准直器为0.75mm，螺距为0.558。两名阅片者评估CTA数据，另外两名不同的阅片者评估DSA数据。记录动脉瘤特征，并提出手术夹闭或血管内弹簧圈栓塞治疗方案。
21例患者的DSA共发现24个动脉瘤。基于每个动脉瘤，CTA的敏感性和特异性分别为100%和83%。DSA与CTA在确定瘤囊和瘤颈大小方面的相关性非常好（分别为r = 0.92和r = 0.95，P < 0.0001）。检测纳入瘤囊或瘤颈的动脉分支的敏感性和特异性分别为50%和100%。在3个动脉瘤中，阅片者认为CTA不适合用于分诊，因为瘤周分支显示不佳。CTA与DSA在24个动脉瘤的手术夹闭和血管内弹簧圈栓塞治疗决策上的总体一致性良好（kappa = 0.76）。
多排螺旋CTA可为动脉瘤的位置以及瘤囊和瘤颈大小提供准确的解剖信息；然而，该技术在检测纳入瘤囊的分支方面似乎敏感性较低。
