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Head and Neck Dual Energy Bone Removal Computed Tomography Angiography Using the Intracranial Aneurysms
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摘要:
目的 研究头颈部双能量去骨计算机断层摄影血管造影(dual energy bone removal computed tomography angiography, DEBR CTA)诊断颅内动脉瘤的准确性, 以数字减影血管造影(digital subtraction angiography, DSA)及三维旋转数字减影血管造影(three-dimensional rotational digital subtraction angiography, 3DRA)为金标准。 方法 回顾性分析本院8例怀疑颅内动脉瘤且均行双能量头颈部CTA、DSA及3DRA的患者。根据载瘤血管位置将颅内动脉分为16个区域, 逐一观察动脉瘤存在情况, 测量动脉瘤各种径线长度, 比较其与DSA/3DRA的一致性。根据动脉瘤最大径分为4组:无, < 3 mm, 3~5 mm, ≥ 5 mm; 分别评价DEBR CTA对动脉瘤大小的评价效果。 结果 8例患者DEBR CTA共发现9个动脉瘤, 全部经过DSA证实。DSA/3DRA及DEBR CTA测量的最大径线分别为(5.2±5.1)和(5.7±5.6)mm, 配对t检验无统计学意义。2例后交通动脉起始处动脉瘤的2条远端供血动脉未被DEBR CTA显示。DEBR CTA评价≥ 5 mm动脉瘤最大径的准确性达100%;1例DEBR CTA评价为 < 3 mm的动脉瘤, DSA/3DRA评价为3~5 mm。 结论 DEBR CTA能有效诊断颅内动脉瘤, 与DSA/3DRA具有较高的一致性。DEBR CTA可能会漏诊接近颅底动脉瘤的远端细小供血动脉并且低估接近颅底的小动脉瘤的大小。 -
关键词:
- 颅内动脉瘤 /
- 双能量断层摄影术，X线计算机 /
- 数字减影血管造影术
Abstract:Objective To evaluate the diagnostic accuracy of dual energy bone removal CT angiography (DEBR CTA) in the detection of intracranial aneurysms, compared with the findings of digital subtraction angiography (DSA) and three-dimensional rotational digital subtraction angiography (3DRA). Methods Eight patiens with suspected intracranial aneurysms underwent dual energy CTA, DSA, and 3DRA. The intracranial arteries were divided into 16 areas according to the locations of tumor-carrying arteries. Aneurysms detected with DEBR CTA was compared with DSA/3DRA findings on a per-patient and a per-aneurysm basis. Aneurysms were classified into four groups according to the maximun diameter, which included:not detected, less than 3 mm, 3-5 mm and more than 5 mm. Results Nine aneurysms were detected by DEBR CTA in eight patients, and all of them were confirmed by DSA/3DRA. The maximum diameter of the aenrysms detected by DSA/3DRA and DEBR CTA was (5.2±5.1) mm and (5.7±5.6) mm, respectively (P > 0.05). Two distal blood-supply arteries of two aneurysms were not detected by DEBR CTA, which were shown by CTA without bone removal and DSA/3DRA. In the detection of aneurysms larger than 5 mm, DEBR CTA had an accuracy of 100%. One considered to be less than 3 mm in DEBR CTA was detected to be 3-5 mm in DSA/3DRA. Conclusions DEBR CTA has a high diagnostic accuracy in the detection of intracranial aneurysms, and has shown good consistence with DSA/3DRA. However, DEBR CTA may miss small distal blood-supply arteries and underestimate the size of small aneurysms near the skull base. -
图 1 双能量去骨CT血管造影示左侧大脑中动脉分叉处1例囊状动脉瘤(箭头)
A. DEBR CTA厚层MIP图像; B. DEBR CTA厚层VR图像; C. 3DRA图像
DEBR CTA:双能量去骨CT血管造影; MIP:最大密度投影; VR:容积再现; 3DRA:三维旋转数字减影血管造影
图 2 左侧颈内动脉C6段动脉瘤影像
A. DEBR CTA示左侧颈内动脉C6段动脉瘤(三角所指)，其远端未见明确供血动脉; B. 3DRA显示左侧颈内动脉C6段一动脉瘤(三角所指)，远端可见一细小供血动脉(黑箭头); C.双能量CTA去骨后MPR图像显示动脉瘤远端瘤体及供血动脉部分像素去除(白箭头); D.双能量CTA去骨前MIP重建图像示动脉瘤远端供血动脉(白箭头)，并证实为后交通动脉
DEBR CTA、3DRA、MIP:同图 1; MPR:多平面重建 -
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