留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

头颈部双能量去骨计算机断层摄影血管造影对颅内动脉瘤的诊断

陈钰 薛华丹 张晓波 刘炜 孙昊 王萱 苏佰燕 何泳蓝 王客非 金征宇

陈钰, 薛华丹, 张晓波, 刘炜, 孙昊, 王萱, 苏佰燕, 何泳蓝, 王客非, 金征宇. 头颈部双能量去骨计算机断层摄影血管造影对颅内动脉瘤的诊断[J]. 协和医学杂志, 2011, 2(3): 246-251. doi: 10.3969/j.issn.1674-9081.2011.03.012
引用本文: 陈钰, 薛华丹, 张晓波, 刘炜, 孙昊, 王萱, 苏佰燕, 何泳蓝, 王客非, 金征宇. 头颈部双能量去骨计算机断层摄影血管造影对颅内动脉瘤的诊断[J]. 协和医学杂志, 2011, 2(3): 246-251. doi: 10.3969/j.issn.1674-9081.2011.03.012
Yu CHEN, Hua-dan XUE, Xiao-bo ZHANG, Wei LIU, Hao SUN, Xuan WANG, Bai-yan SU, Yong-lan HE, Ke-fei WANG, Zheng-yu JIN. Head and Neck Dual Energy Bone Removal Computed Tomography Angiography Using the Intracranial Aneurysms[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(3): 246-251. doi: 10.3969/j.issn.1674-9081.2011.03.012
Citation: Yu CHEN, Hua-dan XUE, Xiao-bo ZHANG, Wei LIU, Hao SUN, Xuan WANG, Bai-yan SU, Yong-lan HE, Ke-fei WANG, Zheng-yu JIN. Head and Neck Dual Energy Bone Removal Computed Tomography Angiography Using the Intracranial Aneurysms[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(3): 246-251. doi: 10.3969/j.issn.1674-9081.2011.03.012

头颈部双能量去骨计算机断层摄影血管造影对颅内动脉瘤的诊断

doi: 10.3969/j.issn.1674-9081.2011.03.012
详细信息
    通讯作者:

    金征宇 电话:010-65295441, 电子邮件:jin_zhengyu@163.com

  • 中图分类号: R814.42;R743

Head and Neck Dual Energy Bone Removal Computed Tomography Angiography Using the Intracranial Aneurysms

More Information
  • 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。
  • 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

    表  1  双能量去骨CT血管造影与数字减影血管造影诊断颅内动脉瘤比较

    DEBR CTA示动脉瘤
    (mm)
    DSA诊断动脉瘤
    (n)
    (mm)DEBR CTA (n)
    诊断动脉瘤 真阳性 真阴性 假阴性 假阳性
    <3 2 3 2 125 0 1
    3 ~ 5 4 3 3 124 1 0
    ≥5 3 3 3 125 0 0
    根据载瘤血管位置将颅内动脉分为16个区域,分别为左右颈内动脉、左右大脑中动脉、左右大脑前动脉、前交通动脉、左右椎动脉、基底动脉、左右大脑后动脉、左右后交通动脉、左右小脑动脉; DEBR CTA:同图 1; DSA:数字减影血管造影
    下载: 导出CSV

    表  2  双能量去骨CT血管造影诊断动脉瘤最大径的准确性

    DSA示动脉瘤(mm) DEBR CTA (%)
    敏感性 特异性 阳性预测值 阴性预测值 准确性
    <3 100 99.2 66. 7 100. 0 99. 2
    3 ~ 5 74 100. 0 100. 0 99. 2 99. 2
    ≥5 100 100. 0 100. 0 100. 0 100. 0
    DEBR CTA:同图 1; DSA:同表 1
    下载: 导出CSV
  • [1] Jayaraman MV, Mayo-Smith WW, Tung GA, et al. Detection of intracranial aneurysms:multidetector row CT angiography compared with DSA[J]. Radiology, 2004, 230:510-518. doi:  10.1148/radiol.2302021465
    [2] Uysal E, Oztora F, Ozel A, et al. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography:comparison with conventional angiograph[J]. Emerg Radiol, 2008, 15:311-316. doi:  10.1007/s10140-008-0727-0
    [3] Brisman JL, Song JK, Newell DW. Cerebral aneurysm[J]. N Engl J Med, 2006, 355:928-939. doi:  10.1056/NEJMra052760
    [4] McKinney AM, Palmer CS, Truwit CL, et al. Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography[J]. Am J Neuroradiol, 2008, 29:594-602. doi:  10.3174/ajnr.A0848
    [5] Lell M, Anders K, Klotz E, et al. Clinical evaluation of bone-subtraction CT angiography (BSCTA) in head and neck imaging[J]. Eur Radiol, 2006, 16:889-897. doi:  10.1007/s0330-005-0032-1
    [6] Venema HW, Hulsmans FJ, den Heeten GJ. CT angiography of the circle of Willis and intracranial internal carotid arteries:maximum intensity projection with matched mask bone elimination-feasibility study[J]. Radiology, 2001, 218:893-898. doi:  10.1148/radiology.218.3.r01mr30893
    [7] Tomandl BF, Hammen T, Klotz E, et al. Bone-subtraction CT angiography for the evaluation of intracranial aneurysms[J]. Am J Neuroradiol, 2006, 27:55-59. http://www.ncbi.nlm.nih.gov/pubmed/16418356
    [8] White PM, Teasdale EM, Wardlaw JM, et al. Intracranial aneurysms:CT angiography and MR angiography for detection prospective blinded comparison in a large patient cohort[J]. Radiology, 2001, 219:739-749. doi:  10.1148/radiology.219.3.r01ma16739
    [9] Hiratsuka Y, Miki H, Kiriyama I, et al. Diagnosis of unruptured intracranial aneurysms:3T MR angiography versus 64-channel multi-detector row CT angiography[J]. Magn Reson Med Sci, 2008, 7:169-178. doi:  10.2463/mrms.7.169
    [10] Yoon DY, Lim KJ, Choi CS, et al. Detection and characterization of intracranial aneurysms with 16-channel multidetector row CT angiography:a prospective comparison of volume-rendered images and digital subtraction angiography[J]. AJNR Am J Neuroradiol, 2007, 28:60-67. http://jnis.bmj.com/lookup/ijlink?linkType=ABST&journalCode=ajnr&resid=28/1/60&atom=%2Fneurintsurg%2F6%2F3%2F169.atom
    [11] Agid R, Lee SK, Willinsky RA, et al. Acute subarachnoid hemorrhage:using 64-slice multidetector CT angiography to "triage" patients' treatment[J]. Neuroradiology, 2006, 48:787-794. doi:  10.1007/s00234-006-0129-5
    [12] Pozzi-Mucelli F, Bruni S, Doddi M, et al. Detection of intracranial aneurysms with 64 channel multidetector row computed tomography:Comparison with digital subtraction angiography[J]. Eur J Radiol, 2007, 64:15-26. doi:  10.1016/j.ejrad.2007.02.018
    [13] Saba L, Sanfilippo R, Pirisi R, et al. Multidetector-row CT angiography in the study of atherosclerotic carotid arteries[J]. Neuroradiology, 2007, 49:623-637. doi:  10.1007/s00234-007-0244-y
    [14] Jayakrishnan VK, White PM, Aitken D, et al. Subtraction helical CT angiography of intra-and extracranial vessels:technical considerations and preliminary experience[J]. AJNR, 2003, 24:451-455. http://europepmc.org/abstract/MED/12917153
    [15] Deng K, Liu C, Ma R, et al. Clinical evaluation of dual energy bone removal in CT angiography of the head and neck:comparison with convertional bone subtraction CT angiography[J]. Clin Radiol, 2009, 64:534-554. doi:  10.1016/j.crad.2009.01.007
    [16] Graser A, Johnson TR, Bader M, et al. Material differentiation by dual energyCT:initial experience[J]. Eur Radiol, 2007, 17:1510-1517. doi:  10.1007/s00330-006-0517-6
    [17] Thomas C, Korn A, Ketelsen D, et al. Automatic lumen Segmentation in calcified plaques:dual energy CT versus standard reconstructions in comparison with digital subtraction angiography[J]. AJR Am J Roentgenol, 2010, 194:1590-1595. doi:  10.2214/AJR.09.3550
    [18] Zhang LJ, Wu SY, Niu JB, et al. Dual-energy CT angiography in the evaluation of intracranial aneurysms:image quality, radiation dose, and comparison with 3D rotational digital subtraction angiography[J]. AJR Am J Roentgenol, 2010, 194:23-30. doi:  10.2214/AJR.08.2290
    [19] Lv F, Li Q, Liao J, et al. Detection and Characterization of Intracranial Aneurysms with Dual-Energy Subtraction CTA:Comparison with DSA[J]. Acta Neurochir Suppl, 2011, 110(Pt 2):239-245. doi:  10.1007/978-3-7091-0356-2_43
  • 加载中
图(2) / 表(2)
计量
  • 文章访问数:  152
  • HTML全文浏览量:  45
  • PDF下载量:  1
  • 被引次数: 0
出版历程
  • 收稿日期:  2011-05-14
  • 刊出日期:  2011-07-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!