Babichev Konstantin Nickolaevich, Savello Aleksandr Viktorovich, Isaeva Alla Vladimirovna, Svistov Dmitrij Vladimirovich, Men'kov Igor' Anatol'evich, Isaev Dzhamaludin Magomedrasulovich
Department of Neurosurgery, Military Medical Academy n. a. S.M. Kirov, 194044, St. Petersburg, Russia.
Department of Neurosurgery, Military Medical Academy n. a. S.M. Kirov, 194044, St. Petersburg, Russia.
Chin J Traumatol. 2025 Mar;28(2):91-95. doi: 10.1016/j.cjtee.2024.12.002. Epub 2025 Jan 22.
To analyze the diagnostic efficacy of computed tomography angiography compared to digital cerebral angiography for the diagnosis of traumatic aneurysms (TAs) associated with combat-related penetrating head injuries and propose the most suitable angiography protocol in this clinical context.
A retrospective analysis was conducted on patients admitted to the neurosurgical clinic for penetrating traumatic brain injuries between February, 2022 and July, 2024, for whom both cerebral multidetector computed tomography angiography (MCTA) and digital cerebral angiography (DCA) were available. The inclusion were patients (1) with penetrating head injuries, (2) with missile trajectory traverses through the Sylvian or great longitudinal fissure, (3) basal cisterns with/or major subarachnoid hemorrhage. The sensitivity, specificity, positive predictive value, and negative predictive value of MCTA were calculated. DCA was considered as the gold standard of diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of MCTA were calculated. Descriptive statistics and nonparametric statistics were used to analyze the study results and their differences, respectively.
A total of 40 patients with 45 TAs were included in the study. Of these, 26 patients (65.0%) were found to have aneurysms on MCTA. The median diameter of the aneurysms diagnosed by MCTA was 4.9 (3.6, 4.8) mm (range of 2.5 - 10.4 mm). However, the mean diameter of TAs not detected by MCTA but diagnosed by DCA was (3.0 ± 1.3) mm (range of 1.3 - 4.9 mm). MCTA demonstrated sensitivity and specificity of 35.5% and 99.5%, respectively, with positive and negative predictive values of 92.3% and 90.7%.
A low sensitivity of MCTA for the diagnosis of TAs associated with combat-related penetrating head injuries was reported. When MCTA is inconclusive in the setting of radiologic predictors of cerebral artery injury, DSA may be required.
分析计算机断层血管造影术与数字脑动脉造影术相比，对与战斗相关的穿透性头部损伤所致创伤性动脉瘤（TA）的诊断效能，并在此临床背景下提出最合适的血管造影方案。
对2022年2月至2024年7月间因穿透性颅脑损伤入住神经外科诊所且同时具备脑多排计算机断层血管造影术（MCTA）和数字脑动脉造影术（DCA）的患者进行回顾性分析。纳入标准为：（1）穿透性头部损伤患者；（2）导弹轨迹穿过外侧裂或大脑纵裂；（3）基底池有和/或主要蛛网膜下腔出血。计算MCTA的敏感性、特异性、阳性预测值和阴性预测值。DCA被视为诊断的金标准。计算MCTA的敏感性、特异性、阳性预测值和阴性预测值。分别采用描述性统计和非参数统计分析研究结果及其差异。
本研究共纳入40例患者，共45个TA。其中，26例患者（65.0%）在MCTA上发现有动脉瘤。MCTA诊断出的动脉瘤中位直径为4.9（3.6，4.8）mm（范围为2.5 - 10.4mm）。然而，未被MCTA检测到但被DCA诊断出的TA平均直径为（3.0±1.3）mm（范围为1.3 - 4.9mm）。MCTA的敏感性和特异性分别为35.5%和99.5%，阳性预测值和阴性预测值分别为92.3%和90.7%。
据报道，MCTA对与战斗相关的穿透性头部损伤所致TA的诊断敏感性较低。当MCTA在脑动脉损伤的放射学预测指标方面不明确时，可能需要进行数字减影血管造影（DSA）。
