本文選題：顱內(nèi)動(dòng)脈瘤　切入點(diǎn)：雙源CT血管造影　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的本研究評價(jià)第二代雙源雙能量CT(dual energy computed tomography,DECT)在CT血管造影(computed tomographic angiography,CTA)診斷顱內(nèi)動(dòng)脈瘤的作用及其應(yīng)用價(jià)值,并與DSA進(jìn)行對比,探索更準(zhǔn)確、更合理的檢查方法,為該病的臨床治療提供有價(jià)值的信息。資料和方法對我院2013年6月~2015年6月收治的經(jīng)診斷疑似為顱內(nèi)動(dòng)脈瘤的受檢者86例進(jìn)行DE-CTA及DSA檢查,年齡32~75歲,平均年齡(54.2±3.5)歲,其中男性36例,女性50例�；颊咧饕兄刖W(wǎng)膜下腔出血(55例,占56.98%)、突發(fā)性頭痛(45例,占46.51%)、腦出血(24例,占22.09%)、一側(cè)動(dòng)眼神經(jīng)出血麻痹(16例,占12.79%)等表現(xiàn),并排除有碘劑過敏史、有嚴(yán)重心功能不全及嚴(yán)重的肝腎功能不良情況,所有患者均征得同意并簽署知情同意書。入院后均進(jìn)行Hunt-Hess評分:0級:6例,Ⅰ級8例,Ⅱ級46例,Ⅲ級22例,Ⅳ級4例。對所有病例均行雙源CT腦血管造影檢查和DSA檢查,以DSA檢查結(jié)果為評價(jià)金標(biāo)準(zhǔn),計(jì)算DE-CTA診斷顱內(nèi)動(dòng)脈瘤的敏感性、特異性、陽性預(yù)測值和陰性預(yù)測值,對比兩種檢查方法對動(dòng)脈瘤的檢出率;比較DE-CTA和DSA對不同大小的瘤體檢出情況和瘤體直徑測量情況;以及對比DE-CTA和DSA對動(dòng)脈瘤瘤頸的顯示清晰度。結(jié)果1.動(dòng)脈瘤診斷情況:以DSA為對照標(biāo)準(zhǔn),86病例中確診72例,發(fā)現(xiàn)82個(gè)動(dòng)脈瘤,14例為陰性患者,DE-CTA發(fā)現(xiàn)66例,74個(gè)動(dòng)脈瘤,漏診6例8個(gè)動(dòng)脈瘤,假陽性2例。兩種檢查手段對顱內(nèi)動(dòng)脈瘤的檢出率比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.診斷效能:以DSA診斷結(jié)果為對照標(biāo)準(zhǔn),DE-CTA診斷顱內(nèi)動(dòng)脈瘤的敏感性為91.6%,特異性為85.7%,陽性預(yù)測值為97.0%,陰性預(yù)測值為66.7%。以動(dòng)脈瘤數(shù)目計(jì)算,DE-CTA診斷動(dòng)脈瘤的敏感性為90.2%,其中對于3mm的微小動(dòng)脈瘤,其診斷敏感性為85.7%,3mm的動(dòng)脈瘤(包括3~5mm的小型動(dòng)脈瘤和體積更大的動(dòng)脈瘤)其診斷敏感性為95.0%。3.瘤體直徑測量結(jié)果比較:DSA測量瘤體直徑為(5.4±2.3)mm,DE-CTA的測量結(jié)果為(5.5±1.8)mm,兩種測量方法所測得的瘤體直徑比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。CTA(VR)所顯示動(dòng)脈瘤圖像不清晰8例,顯示較清晰12個(gè),顯示清晰54個(gè)。DSA無顯示不清晰病例,顯示較清晰12個(gè),顯示清晰62個(gè),秩和檢驗(yàn)結(jié)果顯示兩種檢查手段比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.DE-CTA對診斷顱內(nèi)動(dòng)脈瘤的敏感性和特異性較高,可作為DSA的替代手段用于對顱內(nèi)動(dòng)脈瘤的術(shù)前診斷;并且在動(dòng)脈瘤定量測量與DSA結(jié)果具有很高的相關(guān)性,雖然DE-CTA對微小動(dòng)脈瘤的有一定的漏診率,總的來說仍有較高的應(yīng)用價(jià)值,可以作為疑似顱內(nèi)動(dòng)脈瘤患者的首選篩查方法;2.DE-CTA雙能量技術(shù)僅需進(jìn)行一次增強(qiáng)掃描,便可獲得多組不同數(shù)據(jù)圖像,將其進(jìn)行能量去骨減影和后處理重建,操作簡單快速、創(chuàng)傷性小、成功率高,成為一種臨床有效檢查動(dòng)脈瘤的影像學(xué)方法;3.DSA對于動(dòng)脈瘤瘤頸及載瘤動(dòng)脈的顯示清晰度明顯優(yōu)于DE-CTA,對于后者未能清晰顯示的應(yīng)進(jìn)一步接受DSA檢查。
[Abstract]:Background and objective to evaluate the value of the second generation dual-energy CT(dual energy computed tomographygraphy (DECT) in the diagnosis of intracranial aneurysms by CT angiography and computed tomographic angiography (DSA), and to explore more accurate and reasonable methods for the diagnosis of intracranial aneurysms. Data and methods 86 patients suspected of intracranial aneurysm were examined by DE-CTA and DSA from June 2013 to June 2015. The average age was 54.2 鹵3.5 years. Among them, 36 cases were males and 50 cases were females. There were 55 cases of subarachnoid hemorrhage (56.98%), 45 cases of sudden headache (46.51%), 24 cases of cerebral hemorrhage (22.09%), 16 cases of unilateral oculomotor hemorrhage paralysis (12.79%), and the exclusion of iodine hypersensitivity. There were severe cardiac insufficiency and severe hepatic and renal dysfunction. All the patients obtained consent and signed informed consent. After admission, Hunt-Hess score was given to 6 cases of grade 0: 6, 8 cases of grade 鈪，

本文編號：1630362