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目的评估16层螺旋CT血管成像(CTA)在脑动脉瘤夹闭术后动脉瘤残留和载瘤动脉开放评价中的准确性和临床应用价值。方法44例患者的47个夹闭动脉瘤纳入本研究。患者均行16层螺旋CTA和数字减影血管造影(DSA)检查,DSA作为参考标准。两名神经放射科医师独立评价CTA和DSA的图像质量、动脉瘤残留和载瘤动脉的开放。结果16层螺旋CTA检出3个动脉瘤有残留,靠近钛夹的全部载瘤动脉可以被准确评价。16层螺旋CTA检出动脉瘤残留的敏感性、特异性和准确性分别是100%(97.5%CI:29.2～100%)、100%(97.5%CI:92.0～100%)和100%(97.5%CI:92.5～100%)。阳性和阴性预测率均为100%。结论16层螺旋CTA在诊断脑动脉瘤夹闭术后的残留和载瘤动脉开放方面具有很高的准确性,可以作为动脉瘤夹闭术后随访的首选影像检查。
Objective To evaluate the accuracy and clinical value of 16-slice spiral CT angiography (CTA) in the evaluation of aneurysm residue and open-vessel artery opening after cerebral aneurysm clipping. Methods Totally 47 occlusion aneurysms in 44 patients were included in this study. Patients underwent 16-slice spiral CTA and digital subtraction angiography (DSA) examinations, DSA as a reference standard. Two neuroradiologists independently evaluated the image quality of CTA and DSA, aneurysm residue, and the opening of the parent artery. Results 16-slice spiral CTA detected three aneurysm residues, and all the parent artery close to the titanium clip can be accurately evaluated. The sensitivity, specificity and accuracy of 16-slice CTA for detecting aneurysm residue were 100% (97.5% CI: 29.2-100%), 100% (97.5% CI: 92.0-100%) and 100% (97.5% CI: % CI: 92.5 ~ 100%). The positive and negative predictive rates were 100%. Conclusion The 16-slice spiral CTA has a high accuracy in the diagnosis of residual aneurysms after occlusion of cerebral aneurysms and the opening of the parent artery. It can be used as the first choice of imaging for postoperative follow-up of aneurysm clipping.