三维DSA及二维DSA在颅内动脉瘤诊疗中应用价值比较.doc

三维DSA及二维DSA在颅内动脉瘤诊疗中应用价值比较 　【摘要】 目的 探讨三维数字减影血管造影（3DDSA）在颅内动脉瘤诊疗中的价值及其与二维数字减影血管造影（2DDSA）相比的优势。方法 对53例因蛛网膜下腔出血(SAH)入院而CT疑诊为颅内动脉瘤的患者同时进行2DDSA和3DDSA检查，分别阅片并记录动脉瘤的检出情况、瘤颈显示情况、瘤体与载瘤动脉的关系及对比剂用量和X线照射剂量，对其结果进行比较分析。结果 53例患者中2DDSA诊断46例共49枚动脉瘤，占84.5％（49/58），诊断的阳性率为86.8％（46/53），灵敏度为92％，特异度为81.8％；3DDSA诊断50例共58枚动脉瘤，占100％(58/58)，诊断的阳性率为94.3％（50/53），灵敏度和特异度均为100%。2DDSA检出的动脉瘤中，清楚显示瘤颈者23枚，清楚显示瘤体与载瘤动脉关系者22枚；3DDSA组清楚显示瘤颈者58枚，清楚显示瘤体与载瘤动脉关系者56枚（P＜0.05）。53例患者行2DDSA检查平均所接受的辐射剂量及对比剂用量分别为(178.32±17.39) mGy和(74.57±11.95)mL,行3DDSA检查则为(99.81±9.48)mGy和(54.15±7.05)mL（P＜0.05）。结论 3DDSA能更清晰地显示瘤颈及瘤体与载瘤动脉的关系，提供血管内治疗的最佳工作角度，并能明显减少造影剂的用量和X线辐射剂量，提高了放射防护的安全性。 【关键词】 颅内动脉瘤；成像，三维；脑血管造影术 　　To evaluate 3D digital subtraction angiography (DSA) and 2DDSA in diagnosis of intracranial aneurysms. Method Both 3DDSA and 2DDSA were performed on 53 patients with subarachnoid hemorrhage(SAH) suspected as cerebra1 aneurysms by CT. Results In the 2DDSA group, the accurate rate, positive rate, sensitivity and specificity were respectively 84.5% (49/58), 86.8%(46/53), 92%, and 81.8%. In the 3DDSA group, the accurate rate and positive rate were 100%(58/58) and 94.3%(50/53), and the sensitivity and specificity were both 100%. By 2DDSA, 23 cases of neck of the aneurysm were clearly shown, and 22 cases displayed the source vessel, however, by 3DDSA, 58 cases of neck of the aneurysm and 56 cases of source vessels were clearly shown, the difference between 2D and 3DDSA was significant（P＜0.05）. The mean radiation dose and contrastmedium of 2DDSA were (178.32±17.39) mGy and (74.57±11.95)mL, while those of 3DDSA were (99.81±9.48) mGy and (54.15±7.05) mL, the difference between the two groups was also significant（P＜0.05）. Conclusions The neck of the aneurysm and source vessel are clearer in 3DDSA than in 2DDSA,also the radiation and contrastmedium doses are much lower in 3DDSA than in 2DDSA. 　　Key words: Intracranial aneurysm； Imaging, threedimensional； Cerebral angiography 颅内动脉瘤(intracranial aneurysm,