Westerlaan H E, Gravendeel J, Fiore D, Metzemaekers J D M, Groen R J M, Mooij J J A, Oudkerk M
Department of Radiology, University Medical Center Groningen, Post Box 30.001, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
Neuroradiology. 2007 Dec;49(12):997-1007. doi: 10.1007/s00234-007-0293-2. Epub 2007 Sep 22.
We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA).
Over the period April 2003 to January 2006 in all patients presenting with a subarachnoid haemorrhage CTA was performed primarily. If CTA demonstrated an aneurysm, coiling or clipping was undertaken. IA-DSA was limited to patients with negative or inconclusive CTA findings. We compared CTA images with findings at surgery or coiling in patients with positive CTA findings and in patients with negative and inconclusive findings in whom IA-DSA had been performed.
In this study, 224 consecutive patients (mean age 52.7 years, 135 women) were included. In 133 patients (59%) CTA demonstrated an aneurysm, and CTA was followed directly by neurosurgical (n = 55) or endovascular treatment (n = 78). In 31 patients (14%) CTA findings were categorized as inconclusive, and in 60 (27%) CTA findings were negative. One patient received surgical treatment on the basis of false-positive CTA findings. In 17 patients in whom CTA findings were inconclusive, IA-DSA provided further diagnostic information required for correct patient selection for any therapy. Five ruptured aneurysms in patients with a nonperimesencephalic SAH were negative on CTA, and four of these were also false-negative on IA-DSA. On a patient basis the positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CTA for symptomatic aneurysms were 99%, 90%, 96%, 98% and 96%, respectively.
CTA should be used as the first diagnostic modality in the selection of patients for surgical or endovascular treatment of ruptured intracranial aneurysms. If CTA renders inconclusive results, IA-DSA should be performed. With negative CTA results the complementary value of IA-DSA is marginal. IA-DSA is not needed in patients with negative CTA and classic perimesencephalic SAH. Repeat IA-DSA or CTA should still be performed in patients with a nonperimesencephalic SAH.
我们试图确定在不借助动脉内数字减影血管造影（IA-DSA）的情况下，CT血管造影（CTA）是否可应用于破裂颅内动脉瘤夹闭或栓塞的规划与实施。
在2003年4月至2006年1月期间，对所有蛛网膜下腔出血患者首先进行CTA检查。如果CTA显示有动脉瘤，则进行栓塞或夹闭治疗。IA-DSA仅限于CTA结果为阴性或不确定的患者。我们将CTA图像与CTA结果阳性患者以及CTA结果阴性和不确定且已进行IA-DSA检查患者的手术或栓塞结果进行了比较。
本研究纳入了224例连续患者（平均年龄52.7岁，女性135例）。133例患者（59%）CTA显示有动脉瘤，随后直接进行了神经外科治疗（n = 55）或血管内治疗（n = 78）。31例患者（14%）CTA结果被归类为不确定，60例（27%）CTA结果为阴性。1例患者基于CTA假阳性结果接受了手术治疗。在17例CTA结果不确定的患者中，IA-DSA提供了正确选择治疗方案所需的进一步诊断信息。5例非脑池周围蛛网膜下腔出血患者的破裂动脉瘤CTA结果为阴性，其中4例在IA-DSA上也为假阴性。以患者为基础，CTA对有症状动脉瘤的阳性预测值、阴性预测值、敏感性、特异性和准确性分别为99%、90%、96%、98%和96%。
CTA应作为选择破裂颅内动脉瘤手术或血管内治疗患者的首选诊断方法。如果CTA结果不确定，则应进行IA-DSA检查。CTA结果为阴性时，IA-DSA的补充价值有限。CTA结果为阴性且为典型脑池周围蛛网膜下腔出血的患者不需要进行IA-DSA检查。非脑池周围蛛网膜下腔出血患者仍应重复进行IA-DSA或CTA检查。
