Automatic Bone Removal Dual-Energy CT Angiography for the Evaluation of Intracranial Aneurysms
Automatic Bone Removal Dual-Energy CT Angiography for the Evaluation of Intracranial Aneurysms
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自动去骨双能CT血管造影评估颅内动脉瘤
DOI：
10.1097/rct.0b013e3181eff93c
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发表时间：
2010
影响因子：
1.3
通讯作者：
G. Lu
中科院分区：
文献类型：
--
作者：
L. Zhang;Shengyong Wu;C. S. Poon;Yane Zhao;X. Chai;C. Zhou;G. Lu
目的：评价双能量计算机断层扫描血管造影（DE-CTA）在颅内动脉瘤检测中的诊断准确性，并确定DE-CTA是否提供了足够的信息来指导治疗选择。材料与方法：80例自发性蛛网膜下腔出血患者（31例男性和49例女性;平均[SD]年龄为52 [9]岁）接受了DE-CTA。将DE-CTA的性能与平均加权图像和数字减影血管造影（DSA）创建的常规CTA进行比较。动脉瘤检测的灵敏度和特异性是在每个患者和每个动脉瘤的基础上确定的。根据动脉瘤瘤颈尺寸和/或瘤顶/瘤颈比评估治疗选择。结果如下：以DSA作为参考标准（n = 61; 41例患者的47个动脉瘤），DE-CTA正确检测到41例患者的45个动脉瘤，对应于每例患者的灵敏度和特异性分别为100%和95.0%，而每例动脉瘤的灵敏度和特异性分别为95.7%和95.0%，而传统CTA正确检测了39例患者的43个动脉瘤，对应的敏感性和特异性分别为95.1%和95.0%（基于每例患者）与91.5%和95.0%。每一个动脉瘤DE-CTA和常规CTA对颅内动脉瘤的诊断评价无统计学差异。手术治疗了38个动脉瘤，26个动脉瘤接受了弹簧圈栓塞术，1例患者接受了支架植入术，其余5个动脉瘤接受了随访。双能量CTA正确预测了44个动脉瘤的治疗选择，其中15个动脉瘤接受弹簧圈栓塞，29个动脉瘤接受夹闭。结论：根据本研究，与DSA相比，DE-CTA在检测颅内动脉瘤、可视化颅底动脉瘤形态以及预测大多数自发性蛛网膜下腔出血患者的动脉瘤治疗选择方面具有相当的诊断准确性。
Purpose: To evaluate the diagnostic accuracy of dual-energy computed tomographic angiography (DE-CTA) in the detection of intracranial aneurysms and to determine whether DE-CTA provides adequate information to guide treatment choice. Materials and Methods: Eighty patients (31 men and 49 women; mean [SD] ages of 52 [9] years) with spontaneous subarachnoid hemorrhage underwent DE-CTA. The performance of DE-CTA was compared with conventional CTA created from average weighted images and digital subtraction angiography (DSA). Sensitivity and specificity for aneurysm detection were determined on a per-patient and per-aneurysm basis. The treatment choice was assessed on the basis of aneurysm neck size and/or the dome/neck ratio. Results: With DSA as reference standard (n = 61; 47 aneurysms in 41 patients), DE-CTA correctly detected 45 aneurysms in 41 patients corresponding to sensitivity and specificity of 100% and 95.0% on a per-patient basis versus 95.7% and 95.0% on a per-aneurysm basis, whereas conventional CTA correctly detected 43 aneurysms in 39 patients corresponding to sensitivity and specificity of 95.1% and 95.0% on a per-patient basis versus 91.5% and 95.0% on a per-aneurysm basis. No statistical difference between DE-CTA and conventional CTA was found for the diagnostic evaluation of intracranial aneurysms. Surgery was performed to treat 38 aneurysms, coiling in 26 aneurysms, stent in one patient, and follow-up in the remaining 5 aneurysms. Dual-energy CTA correctly predicted treatment choice in 44 aneurysms, with 15 aneurysms coiled and 29 aneurysms clipped. Conclusions: Compared with DSA, DE-CTA had a comparable diagnostic accuracy for the detection of intracranial aneurysms, visualization of the morphology of aneurysms at the skull base, and prediction of aneurysm treatment choice in most patients with spontaneous subarachnoid hemorrhage based on this study.