【摘要】 目的 探讨非减影和减影320排容积CT血管造影(VCTA)在颅内动脉瘤诊断和治疗中的临床应用价值。方法 疑有颅内动脉瘤的312例患者全部行320排VCTA和3D DSA检查。以3D DSA作为参考标准，评价非减影和减影VCTA诊断颅内动脉瘤的敏感性、特异性和准确性。结果 3D DSA确诊了268个颅内动脉瘤。非减影VCTA发现了261动脉瘤(1个假阳性，8个假阴性)。非减影VCTA诊断颅内动脉瘤的敏感性、特异性和准确性分别为97.0%、98.9%和97.5%。减影VCTA发现了267个动脉瘤(1个假阳性，2个假阴性)。减影VCTA诊断颅内动脉瘤的敏感性、特异性和准确性分别为99.3%、98.9%和99.2%。减影VCTA和3D DSA的准确性差异无统计学意义(P=1.000)。然而，非减影VCTA与3D DSA和减影VCTA的准确性差异有统计学意义(P=0.038和0.031)。基于VCTA图像，15个颅内动脉瘤推荐行外科手术治疗，所有动脉瘤成功夹闭。在VCTA的基础上，199个颅内动脉瘤发现适合行血管内栓塞，其中194个动脉瘤成功栓塞。结论 320排减影VCTA技术可以作为颅内动脉瘤外科手术和血管内治疗的首选影像学诊断方法，非减影VCTA诊断颅内动脉瘤的准确性比减影VCTA低，特别是临近骨组织的颅内动脉瘤。更多还原

【Abstract】 Objective To investigate the clinical value of non-subtracted and subtracted 320-detector volume CT angiography(VCTA) in the diagnosis and treatment of intracranial aneurysms.Methods A total of 312 patients with suspected intracranial aneurysms underwent 320-detector VCTA and 3D digital subtraction angiography(3D DSA).3D DSA was used as the reference to evaluate the sensitivity, specificity, and accuracy of non-subtracted and subtracted VCTA for the diagnosis of intracranial aneurysms.Results 3D DSA diagnosed 268 intracranial aneurysms.Non-subtracted VCTA detected 261 aneurysms(1 false-positive reading, 8 false-negative readings). The diagnostic sensitivity, specificity, and accuracy of non-subtracted VCTA were 97.0%,98.9%,and 97.5%,respectively.Subtracted VCTA detected 267 aneurysms(1 false-positive reading, 2 false-negative readings).The sensitivity, specificity, and accuracy of subtracted VCTA were 99.3%,98.9%, and 99.2%,respectively.No significant difference between subtracted VCTA and 3D DSA was observed for accuracy(P=1.000),but significant differences in the accuracy between non-subtracted VCTA and 3D DSA and between non-subtracted VCTA and subtracted VCTA were observed(P=0.038, 0.031).Based on VCTA images, surgical treatment was recommended for 15 patients, and all 15 intracranial aneurysms were successfully clipped. Moreover, 199 aneurysms were found suitable for endovascular coiling, of which 194 aneurysms were treated successfully.Conclusion 320-detector subtracted VCTA method is the preferred diagnostic imaging method for surgical treatment and endovascular embolization of intracranial aneurysms.Non-subtracted VCTA is less accurate than subtracted VCTA for the diagnosis of intracranial aneurysms, especially for aneurysms that are near the bone tissue.更多还原