Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling.
Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling.
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DOI：
10.1007/s00234-007-0293-2
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发表时间：
2007-12
期刊：
影响因子：
2.8
通讯作者：
Oudkerk, M.
中科院分区：
文献类型：
--
作者：
Westerlaan, H. E.;Gravendeel, J.;Fiore, D.;Metzemaekers, J. D. M.;Groen, R. J. M.;Mooij, J. J. A.;Oudkerk, M.
我们试图确定CT血管造影术（CTA）是否可以应用于破裂颅内动脉瘤的夹闭或弹簧圈栓塞术的计划和实施，而无需求助于动脉内数字减影血管造影术（IA-DSA）。在2003年4月至2006年1月期间，主要对所有蛛网膜下腔出血患者进行了CTA。如果CTA显示动脉瘤，则进行弹簧圈栓塞或夹闭。IA-DSA仅限于CTA结果阴性或不确定的患者。我们比较了CTA阳性患者和阴性和不确定结果的患者的CTA图像与手术或弹簧圈栓塞术的结果，这些患者都进行了IA-DSA。在这项研究中，224名连续患者（平均年龄52.7岁，135名女性）被纳入。在133例患者（59%）中，CTA显示动脉瘤，CTA后直接进行神经外科（n = 55）或血管内治疗（n = 78）。31例患者（14%）的CTA结果被归类为不确定，60例（27%）CTA结果为阴性。1例患者在CTA假阳性结果的基础上接受了手术治疗。在17例CTA结果不确定的患者中，IA-DSA提供了正确选择患者进行任何治疗所需的进一步诊断信息。非中脑周围SAH患者的5个破裂动脉瘤在CTA上呈阴性，其中4个在IA-DSA上也为假阴性。以患者为基础，CTA对症状性动脉瘤的阳性预测值、阴性预测值、敏感性、特异性和准确性分别为99%、90%、96%、98%和96%。CTA应作为选择手术或血管内治疗破裂颅内动脉瘤患者的首选诊断方法。如果CTA结果不确定，则应进行IA-DSA。CTA阴性时，IA-DSA的互补价值很小。CTA阴性和典型的中脑周围SAH患者不需要IA-DSA。非中脑周围SAH患者仍应重复IA-DSA或CTA。
We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). Over the period April 2003 to January 2006 in all patients presenting with a subarachnoid haemorrhage CTA was performed primarily. If CTA demonstrated an aneurysm, coiling or clipping was undertaken. IA-DSA was limited to patients with negative or inconclusive CTA findings. We compared CTA images with findings at surgery or coiling in patients with positive CTA findings and in patients with negative and inconclusive findings in whom IA-DSA had been performed. In this study, 224 consecutive patients (mean age 52.7 years, 135 women) were included. In 133 patients (59%) CTA demonstrated an aneurysm, and CTA was followed directly by neurosurgical (n = 55) or endovascular treatment (n = 78). In 31 patients (14%) CTA findings were categorized as inconclusive, and in 60 (27%) CTA findings were negative. One patient received surgical treatment on the basis of false-positive CTA findings. In 17 patients in whom CTA findings were inconclusive, IA-DSA provided further diagnostic information required for correct patient selection for any therapy. Five ruptured aneurysms in patients with a nonperimesencephalic SAH were negative on CTA, and four of these were also false-negative on IA-DSA. On a patient basis the positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CTA for symptomatic aneurysms were 99%, 90%, 96%, 98% and 96%, respectively. CTA should be used as the first diagnostic modality in the selection of patients for surgical or endovascular treatment of ruptured intracranial aneurysms. If CTA renders inconclusive results, IA-DSA should be performed. With negative CTA results the complementary value of IA-DSA is marginal. IA-DSA is not needed in patients with negative CTA and classic perimesencephalic SAH. Repeat IA-DSA or CTA should still be performed in patients with a nonperimesencephalic SAH.
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影响因子：
4.8
作者：
Hoh, BL;Cheung, AC;Ogilvy, CS
通讯作者：
Ogilvy, CS
影响因子：
2.8
作者：
Dammert, S;Krings, T;Thron, A
通讯作者：
Thron, A
影响因子：
2.4
作者：
González-Darder, JM;Pesudo-Martínez, JV;Feliu-Tatay, RA
通讯作者：
Feliu-Tatay, RA
影响因子：
3.3
作者：
Ng, SH;Wong, HF;Wan, YL
通讯作者：
Wan, YL
影响因子：
2.4
作者：
Pechlivanis, I;Schmieder, K;Harders, A
通讯作者：
Harders, A