Romero Javier M, Artunduaga Maddy, Forero N Paola, Delgado Josser, Sarfaraz Kiran, Goldstein Joshua N, Gonzalez R Gilberto, Schaefer Pamela W
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Emerg Radiol. 2009 May;16(3):195-201. doi: 10.1007/s10140-008-0785-3. Epub 2009 Jan 9.
The objective of this study is to measure the accuracy of multidetector CT angiography (MD CTA) in the detection of vascular abnormalities in patients <or=40 years with spontaneous intraparenchymal hemorrhage (IPH) presenting to the emergency department. After institutional review board approval, a retrospective study was performed of 43 consecutive patients <or=40 years, who presented to our emergency department with IPH and that were evaluated with MD CTA. MD CTA images were reviewed by a neuroradiologist to determine IPH location, presence of a vascular abnormality, and associated extraparenchymal hemorrhage. Diagnostic accuracy was measured comparing it to the available reference standards, which included conventional catheter angiogram (CCA), surgical macroscopic findings, and pathology results. Medical records were reviewed for risk factors and correlation with final diagnosis. MD CTA demonstrated an accuracy of 97.7%, with a sensitivity of 96.4% (95% CI 0.79-0.99) and a specificity of 100% (95% CI 0.74-0.99) for the detection of vascular abnormalities in young patients with IPH. Additionally, MD CTA had a PPV of 100%, and the NPV 93.8% in this population. Of the 43 patients included in the study, 28 patients (65%) had a causative vascular etiology for the IPH. Among the 28 patients with vascular etiologies for the IPH, 11 had an AVM (39.2%), nine a ruptured aneurysm (32.14%), seven dural venous sinus thrombosis (25%), and one had vasculitis (3.57%). MD CTA is highly accurate in the detection of vascular abnormalities in the setting of IPH, which as a group represents the most frequent etiology of IPH among patients age <or=40 years. MD CTA performed in the Emergency Department provides accurate, rapid and critical presurgical and premedical treatment information in young patients with IPH.
本研究的目的是测量多排螺旋CT血管造影（MD CTA）在检测急诊科就诊的40岁及以下自发性脑实质内出血（IPH）患者血管异常方面的准确性。经机构审查委员会批准后，对40岁及以下连续43例因IPH到我院急诊科就诊并接受MD CTA检查的患者进行了回顾性研究。由神经放射科医生对MD CTA图像进行评估，以确定IPH的位置、血管异常的存在情况以及相关的脑实质外出血。通过与包括传统导管血管造影（CCA）、手术宏观发现和病理结果在内的可用参考标准进行比较来测量诊断准确性。查阅病历以了解危险因素及其与最终诊断的相关性。MD CTA对40岁及以下IPH年轻患者血管异常检测的准确率为97.7%，灵敏度为96.4%（95%可信区间0.79 - 0.99），特异度为100%（95%可信区间0.74 - 0.99）。此外，在该人群中，MD CTA的阳性预测值为100%，阴性预测值为93.8%。在纳入研究的43例患者中，28例（65%）的IPH有血管病因。在这28例有IPH血管病因的患者中，11例为动静脉畸形（AVM，39.2%），9例为破裂动脉瘤（32.14%），7例为硬脑膜静脉窦血栓形成（25%），1例为血管炎（3.57%）。MD CTA在IPH情况下检测血管异常的准确性很高，IPH作为一个群体是40岁及以下患者中IPH最常见的病因。在急诊科进行的MD CTA可为年轻IPH患者提供准确、快速且关键的术前和术前治疗信息。
