Preda L, Gaetani P, Rodriguez y Baena R, Di Maggio E M, La Fianza A, Dore R, Fulle I, Solcia M, Cecchini A, Infuso L, Campani R
Istituto di Radiologia, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia, Italy.
Eur Radiol. 1998;8(5):739-45. doi: 10.1007/s003300050465.
We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 +/- 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 +/- 0.12 cm vs 1.09 +/- 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients.
我们通过将螺旋计算机断层血管造影（CTA）与选择性血管造影及手术结果进行比较，研究了CTA在检测和研究颅内动脉瘤方面的准确性。26例疑似颅内动脉瘤患者（9例男性，17例女性；平均年龄53.1±1.8岁），在常规CT检查显示19例蛛网膜下腔出血（SAH）以及7例因其他原因进行神经放射学检查后，接受了CTA检查（层厚1 - 2mm，螺距1:1，扫描时间24s，管电流调制指数RI = 1）。以5ml/s的速率静脉注射120 - 150ml碘对比剂（0.3 - 0.4gI/ml），并通过预注射试验团注计算延迟12 - 25s。从轴位图像获得三维表面阴影显示（3D SSD）和最大密度投影（MIP）重建图像。然后，在48小时内，所有患者均接受了数字减影血管造影（DSA），并分别对CTA和DSA的结果进行评估。CTA显示的22个动脉瘤在DSA及手术中得到证实（真阳性），而2例血管病变在DSA中未得到证实（假阳性）。7例患者CTA及后续DSA均排除了颅内动脉瘤的存在（真阴性），且无假阴性；敏感性为100%，特异性为77.8%，诊断准确性为93.5%。CTA显示的动脉瘤位置在所有病例的手术中均得到证实，在评估动脉瘤颈的存在方面具有很高的准确性（100%）。CTA在22例中的20例准确描绘了动脉瘤的形状，但有2例未能描绘出其多叶性质。CTA计算的动脉瘤平均直径为0.99±0.12cm，而手术中测量为1.09±0.11cm（p < 0.01）。目前的结果表明，如果进一步研究得到证实，CTA的高敏感性可能有助于避免在SAH患者CTA结果为阴性后仍需进行动脉造影。
