Multislice computerized tomography angiography in the evaluation of intracranial aneurysms: a comparison with intraarterial digital subtraction angiography.
Multislice computerized tomography angiography in the evaluation of intracranial aneurysms: a comparison with intraarterial digital subtraction angiography.
复制标题
多层计算机断层扫描血管造影评估颅内动脉瘤：与动脉内数字减影血管造影的比较。
作者：
M. Wintermark;A. Uské;Marc Chalaron;L. Regli;P. Maeder;R. Meuli;P. Schnyder;S. Binaghi
目的
本研究的目的是通过将计算机断层扫描（CT）血管造影与动脉内数字减影（IADS）血管造影进行比较，评估借助多层技术（MSCT血管造影）进行的计算机断层扫描（CT）血管造影在颅内动脉瘤研究中的诊断准确性。
方法
前瞻性鉴定了 50 名连续接受 MSCT 血管造影（四排）和 IADS 颅内血管造影的成年患者。 MSCT 血管造影研究由 1.25 毫米切片组成，重建间隔为 0.8 毫米，节距为 0.75，时间由测试推注确定。两名神经放射科医生对 MSCT 血管造影和 IADS 血管造影的初步解释不知情，独立审查了 MSCT 血管造影以检测和表征颅内动脉瘤。 40 名患者中发现了 49 个颅内动脉瘤；其中 33 个病变导致蛛网膜下腔出血。 MSCT 血管造影检测颅内动脉瘤的敏感性、特异性和准确性（按每个动脉瘤计算）分别为 94.8%、95.2% 和 94.9%；按每个患者计算，分别为 99%、95.2% 和 98.3%。观察者间一致性为 98%。使用 MSCT 血管造影评估的动脉瘤大小与通过 IADS 血管造影确定的动脉瘤大小之间存在极好的相关性（斜率 = 0.916，r = 0.877，p < 0.001）；然而，2毫米是截止尺寸，低于该尺寸MSCT血管造影的敏感性在统计学上较低。该方法在表征动脉瘤的形态特征方面显示出很高的准确性。
结论
多层 CT 血管造影是一种准确、稳健的颅内动脉瘤无创筛查测试。它的性能比报道的单层 CT 血管造影更好。八排尤其是 16 排 MSCT 血管造影的引入将通过更薄的切片、更低的螺距和纯动脉期提供进一步的进展。
OBJECT
The goal of this study was to assess the diagnostic accuracy of computerized tomography (CT) angiography performed with the aid of multislice technology (MSCT angiography) in the investigation of intracranial aneurysms, by comparing this method with intraarterial digital subtraction (IADS) angiography.
METHODS
Fifty consecutive adult patients, who successively underwent MSCT angiography (four rows) and IADS angiography of intracranial vessels, were prospectively identified. The MSCT angiography studies consisted of 1.25-mm slices, with 0.8-mm reconstruction intervals, a pitch of 0.75, and timing determined by a test bolus. Two neuroradiologists, who were blinded to the initial interpretation of the MSCT angiograms as well as to those of the IADS angiograms, independently reviewed the MSCT angiograms for the detection and characterization of intracranial aneurysms. Forty-nine intracranial aneurysms were identified in 40 patients; 33 of these lesions were responsible for subarachnoid hemorrhage. The sensitivity, specificity, and accuracy of MSCT angiography in the detection of intracranial aneurysms were 94.8, 95.2, and 94.9%, respectively, on a per-aneurysm basis and 99, 95.2, and 98.3%, respectively, on a per-patient basis. Interobserver agreement was 98%. There was an excellent correlation between aneurysm size assessed using MSCT angiography and that determined by IADS angiography (slope = 0.916, r = 0.877, p < 0.001); however, 2 mm stood as the cutoff size below which the sensitivity of MSCT angiography was statistically lower. That method displayed great accuracy in characterizing the morphological characteristics of the aneurysm.
CONCLUSIONS
Multislice CT angiography is an accurate and robust noninvasive screening test for intracranial aneurysms. It performs better than that reported for single-slice CT angiography. Introduction of eight- and especially 16-row MSCT angiography will provide further progression through thinner slices, a lower pitch, and a purely arterial phase.