颅内硬脑膜动静脉瘘：64 排 CT 血管造影诊断与评估。
Intracranial dural arteriovenous fistulas: diagnosis and evaluation with 64-detector row CT angiography.
机构信息
Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Taipei, Taiwan, Republic of China.
出版信息
Radiology. 2010 Jul;256(1):219-28. doi: 10.1148/radiol.10091835.
PURPOSE
To analyze the diagnostic effectiveness and application of computed tomographic (CT) angiography by using a new algorithm (hybrid CT angiography) in dural arteriovenous fistulas (AVFs).
MATERIALS AND METHODS
Institutional review board approval was obtained for retrospectively postprocessing the raw data from CT angiography by using hybrid CT, which is a mixture of a bone subtraction and masking method for bone removal. The study included 22 patients with 24 dural AVFs and 14 control subjects. The grades in patients with dural AVF determined with hybrid CT angiography and digital subtraction angiography (DSA) were compared, and hybrid CT angiography was applied as a tool for planning endovascular treatment. The adjusted Wald method was used to estimate confidence intervals (CIs), and the Cohen kappa statistic was used to assess interobserver agreement.
RESULTS
Hybrid CT angiography in the 24 dural AVFs revealed asymmetric sinus enhancement in 22 lesions (92%), engorged arteries in 19 (79%), transosseous enhanced vessels in 19 (79%), engorged extracranial veins in 13 (54%), engorged cortical veins in seven (29%), and sinus thrombosis in four (17%). In all 24 lesions, at least two of six imaging signs for diagnosis of dural AVFs were present. The kappa test analysis revealed a high level of interobserver agreement (kappa, 0.56-1.00) in reading the diagnostic imaging signs. The observed agreement between DSA and readers was 100% in the cavernous sinus region and in hypoglossal and clival lesions and 78%-89% in the transverse sigmoid sinus. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 0.93 (95% CI: 0.85, 0.97), 0.98 (95% CI: 0.93, 1.00), 0.97 (95% CI: 0.90, 0.99), and 0.95 (95% CI: 0.90, 0.98), respectively.
CONCLUSION
Hybrid CT angiography is a promising tool for the diagnosis of dural AVF. It can provide key information necessary for treatment planning.
目的
通过使用一种新的算法（混合 CT 血管造影）分析硬脑膜动静脉瘘（dural arteriovenous fistulas，dAVFs）中 CT 血管造影的诊断效果和应用。
材料与方法
回顾性地对混合 CT 血管造影的原始数据进行后处理，该方法是一种骨减法和骨掩蔽方法的混合物，获得机构审查委员会的批准。研究纳入了 22 例 24 个硬脑膜动静脉瘘患者和 14 例对照患者。对比患者的硬脑膜动静脉瘘分级与数字减影血管造影（digital subtraction angiography，DSA），并将混合 CT 血管造影作为血管内治疗计划的工具。采用调整 Wald 方法估计置信区间（confidence intervals，CI），采用 Cohen kappa 统计量评估观察者间的一致性。
结果
24 例硬脑膜动静脉瘘中，混合 CT 血管造影显示 22 个病变（92%）有不对称的窦增强，19 个病变（79%）有动脉怒张，19 个病变（79%）有穿颅增强血管，13 个病变（54%）有颅外静脉怒张，7 个病变（29%）有皮质静脉怒张，4 个病变（17%）有窦血栓形成。所有 24 个病变中，至少有 6 种硬脑膜动静脉瘘诊断影像学征象中的 2 种存在。Kappa 检验分析表明，阅读诊断影像学征象的观察者间一致性较高（kappa=0.56-1.00）。DSA 与观察者在海绵窦区和舌下神经管及斜坡病变处的一致性为 100%，在横窦处的一致性为 78%-89%。总体敏感性、特异性、阳性预测值和阴性预测值分别为 0.93（95%CI：0.85，0.97）、0.98（95%CI：0.93，1.00）、0.97（95%CI：0.90，0.99）和 0.95（95%CI：0.90，0.98）。
结论
混合 CT 血管造影是硬脑膜动静脉瘘诊断的一种很有前途的工具，可为治疗计划提供必要的关键信息。
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