Treatment decision in ruptured intracranial aneurysms: comparison between multi-detector row CT angiography and digital subtraction angiography
Treatment decision in ruptured intracranial aneurysms: comparison between multi-detector row CT angiography and digital subtraction angiography
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DOI：
10.1016/j.neurad.2007.07.006
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发表时间：
2007-10-01
影响因子：
3.5
通讯作者：
Lederc, X.
中科院分区：
文献类型：
--
作者：
Taschner, C.-A.;Thines, L.;Lederc, X.
目标。-本研究的目的是确定多探测器计算机断层血管成像(CTA)对急性破裂动脉瘤患者分流的准确性，并评估基于该方法的治疗决策与数字减影血管成像(DSA)的比较。-27例连续的急性蛛网膜下腔出血患者接受了CTA和DSA检查。CTA在16排CT扫描机上进行，准直为0.75 mm，束间距为0.558。两名读者审阅了CTA数据，两名不同读者审阅了DSA数据。记录动脉瘤的特点，并提出手术夹闭或血管内弹簧圈置入术的治疗方案。-21例患者在DSA上共发现24个动脉瘤。以每个动脉瘤为基础，CTA的敏感性和特异性分别为100%和83%。DSA和CTA在确定囊径和颈径方面的相关性很好(分别为r=0.92p<；0.0001)。检测动脉瘤囊内或颈动脉分支的敏感性和特异性分别为50%和100%。在三个动脉瘤中，读者认为CTA不适合分诊，因为动脉瘤周围的分支没有显示出来。在24个动脉瘤中，CTA和DSA对于手术夹闭和血管内弹簧圈植入的治疗决策的总体一致性良好(K=0.76)。-多层螺旋CTA可提供准确的动脉瘤位置、囊腔和颈部大小的解剖信息；然而，该技术在检测动脉瘤囊内合并的分支方面似乎具有两种敏感性。(C)2007年爱思唯尔·马森公司。保留AR权利。
Objective. - The aim of this study was to determine the accuracy of mutti-detector row computed tomography angiography (CTA) for the triage of patients with acutely ruptured aneurysms, and to assess how therapeutic decisions based on this method compared with digital subtraction angiography (DSA).Methods. - Twenty-seven consecutive patients with acute subarachnoid hemorrhage were included, and underwent both CTA and DSA. CTA was performed on a 16-detector row CT scanner with a 0.75-mm collimation and a 0.558-beam pitch. Two readers reviewed the CTA data, and two different readers reviewed the DSA data. Aneurysm characteristics were recorded and treatment by surgical clipping or endovascular coil embotization was proposed.Results. - A total of 24 aneurysms were identified on DSA in 21 patients. Sensitivity and specificity for CTA were 100% and 83%, respectively, on a per- aneurysm -basis. The correlation between DSA and CTA for the determination of sac and neck sizes was very good (r = 0.92, and r = 0.95, respectively, P < 0.0001). Sensitivity and specificity for the detection of arterial branches incorporated into the aneurysmal sac or neck were 50% and 100%, respectively. In three aneurysms, readers judged CTA inappropriate for triage, because peri-aneurysmat branches were not property visualized. Overall agreement between CTA and DSA regarding the therapeutic decision between surgical clipping and endovascular coil embotization in 24 aneurysms was good (K = 0.76).Conclusion. - Multi-detector row CTA provides accurate anatomic information for aneurysm location as well as sac and neck sizes; however, the technique appears to have a tow sensitivity in detecting branches incorporated into the aneurysmal sac. (C) 2007 Elsevier Masson SAS. AR rights reserved.