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目的:评价CTA在诊断及治疗颅内动脉瘤中的临床应用价值。方法:97例临床疑似颅内动脉瘤患者中首先随机选择CTA及MRA两种无创伤检查中的一种,随后均行DSA检查。以DSA和外科手术确诊为参考,比较CTA,MRA及DSA在诊断颅内动脉瘤中的优势和不足。选择相应治疗后,行CTA+DSA或MRA+DSA复查,评价动脉瘤的残留情况。结果:1 50例行CTA+DSA检查组中,确诊阳性病例46例。CTA检测的特异性、灵敏性及准确性分别为66.67%、100%和98%。阴性及阳性预测率分别为100%和97.92%。DSA检测的特异性、灵敏性及准确性分别为66.67%、95.74%和94%。阴性及阳性预测率分别为50%和97.83%。2 47例行MRA+DSA检查组中,确诊阳性病例45例。MRA检测的特异性、灵敏性及准确性分别为50%、97.67%和93.62%。阴性及阳性预测率分别为66.67%和95.45%。DSA检测的特异性、灵敏性及准确性分别为66.67%、97.73%和95.74%。阴性及阳性预测率分别为66.67%和97.73%。3 48例接受动脉瘤颈夹闭术的患者行CTA+DSA复查,以DSA为标准,CTA评价动脉瘤残留的特异性、灵敏性及准确性分别为97.73%、100%和97.78%。42例接受可解脱弹簧圈治疗的患者行MRA+DSA复查,以DSA为标准,MRA评价动脉瘤残留的特异性、灵敏性及准确性分别为100%、66.67%和97.5%。结论:CTA诊断颅内动脉瘤的特异性、灵敏性及准确性稍优于DSA,MRA对于颅内动脉瘤的诊断方面稍低于DSA;同时CTA及MRA均可清晰显示动脉瘤的三维结构及空间关系;综合比较,我们认为CTA对于动脉瘤的诊断及手术方案的确定能提供更多的信息,并可作为术后较为理想的随访影像学检查方法。
Objective: To evaluate the clinical value of CTA in the diagnosis and treatment of intracranial aneurysms. Methods: 97 patients with suspected intracranial aneurysm were randomly selected one of the two noninvasive CTA and MRA procedures, followed by DSA. To DSA and surgical diagnosis as a reference, compared CTA, MRA and DSA in the diagnosis of intracranial aneurysms in the strengths and weaknesses. Select the appropriate treatment, line CTA DSA or MRA DSA review, evaluate the aneurysm residue. Results: Of the 50 routine CTA + DSA examinations, 46 were confirmed positive cases. The specificity, sensitivity and accuracy of CTA were 66.67%, 100% and 98% respectively. Negative and positive predictive rates were 100% and 97.92%, respectively. The specificity, sensitivity and accuracy of DSA were 66.67%, 95.74% and 94% respectively. Negative and positive predictive rates were 50% and 97.83% respectively. Among 477 MRA + DSA patients, 45 cases were positive. The specificity, sensitivity and accuracy of MRA were 50%, 97.67% and 93.62% respectively. Negative and positive predictive rates were 66.67% and 95.45% respectively. The specificity, sensitivity and accuracy of DSA were 66.67%, 97.73% and 95.74% respectively. Negative and positive predictive rates were 66.67% and 97.73% respectively. The specificity, sensitivity and accuracy of CTA in assessing the residual aneurysm were 97.73%, 100% and 97.78% respectively in 3 48 patients undergoing aneurysm neck clipping by CTA + DSA. Forty-two patients treated with detachable coil were examined with MRA + DSA. The specificity, sensitivity and accuracy of MRA in evaluating aneurysm residue were 100%, 66.67% and 97.5%, respectively, using DSA as the standard. Conclusions: The specificity, sensitivity and accuracy of CTA in diagnosis of intracranial aneurysms are slightly better than that of DSA. MRA is slightly lower than DSA in the diagnosis of intracranial aneurysms. CTA and MRA can clearly show the three-dimensional structure of aneurysms and In a comprehensive comparison, we believe that CTA can provide more information for the diagnosis of aneurysms and the determination of surgical plans, and can be used as an ideal follow-up imaging method after surgery.