顱內血管瘤之電腦斷層血管攝影診斷; Three dimensional CT angiography in the detection of intracranial aneurysms

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题名:	顱內血管瘤之電腦斷層血管攝影診斷;Three dimensional CT angiography in the detection of intracranial aneurysms
作者:	林奎利;Kuei Li Lin
贡献者:	中國醫藥學院醫學研究所
关键词:	電腦斷層血管攝影;電腦斷層掃瞄;動脈瘤;蜘蛛網膜下腔出血;CT angiography;Computed tomography;Aneurysm;Subarachnoid hemorrhage
日期:	1999
上传时间:	2009-12-02 14:12:19 (UTC+8)
摘要:	中文摘要目的: 顱內動脈瘤破裂所導致蜘蛛膜下腔出血，其死亡率高達42.2%，而且又極易再次破裂出血，若再破裂的話，死亡率更高達48%。所以，預防因動脈瘤破裂而造成嚴重損傷的最好方法是增加對顱內動脈瘤存在的辨識能力。本研究在於評估電腦斷層血管攝影分別診斷動脈瘤及疑有顱內動脈瘤症狀的患者，其敏感率及專一率。並且評估電腦斷層血管攝影作為診斷動脈瘤患者第一線工具之優缺點。材料與方法: 自民國85年5月至民國88年6月，共有102例病患懷疑動脈瘤而接受顱內的CTA檢查。每一CTA檢查均包括MIP及SSD，我們分別分析其顱內動脈瘤形狀及表現，而以DSA 及手術所見作為對照組。結果: 共有95 名患者進入分析(平均年齡56歲，年紀最小23歲，最大86歲，男性43名，女性60名)，7名因未做DSA而排除。在66名患者中共發現有74個顱內動脈瘤，分別針對動脈瘤及病患，CTA其敏感率及專一率，分別為93.9%及89.6%,91.8%及85.7%。結論: 藉著高敏感率及專一率，CTA 已取代傳統血管攝影技術，成為診斷顱內動脈瘤的高準確度工具，它不僅提供三度空間影像，並且提供外科開刀前的藍圖資訊，包括：顱內動脈瘤的大小、形狀、頸部位置、周邊血管及骨頭相關位置。CTA成為診斷顱內動脈瘤的第一線常規，當CTA無法確切診斷或診斷有疑點時，才進行傳統的血管攝影，以減少不必要的侵入性檢查。藉著對病患高敏感率及專一率，加上其不侵入性及價錢便宜，CTA可以使用在高危險群的篩檢及顱內動脈瘤未加以治療患者的追蹤檢查。當然，了解CTA的優缺點、先天性的極限，當使我們在作顱內動脈瘤CTA診斷時，更能提高診斷率減少誤判。; 英文摘要 PURPOSE: The purposes of this study are, first, to evaluate the diagnosis sensitivity and specificity of CTA in intracranial arterial aneurysm and, second, to assess the advantages and pitfalls of its role as the first-line diagnostic tool for spontaneous SAH and for the patients suspected of having intracranial aneurysm due to others symptoms. MATERIALS AND METHODS: During the period form May 1996 to June 1999, We performed CTA with MIP and SSD for 102 patients with suspicion of intracranial aneurysm. We analyzed the presence and morphology of any aneurysms. DSA or surgery acted as the control. RESULTS: 95 patients were eligible for analysis. (mean age, 56.8years; range, 23 to 86 years; 43 were male and 60 were women). 74 aneurysms were found in 66 patients. Negative findings at angiography was noted in 7 patients. Sensitivity and specificity of 3-D CTA for all patients and all aneurysm were 93.9% and 89.6%, 91.8% and 85.7%, respectively. CONCLUSION: CTA with its high sensitivity and specificity for aneurysms can compliment conventional catheter angiography for its better demonstration of the 3-D anatomy. It can provide surgical information about the shape, neck, direction of aneurysms, and adjacent vascular and bone structures. CTA can be the first-line diagnostic tool for SAH routinely. DSA can be the adjunct to CTA, if CTA can’t confirm the diagnosis. CTA with its high sensitivity and specificity for all patients may be useful in the follow-up of untreated aneurysms and “at-risk” groups due to it is less invasive and less expensive. Recognition of the limitations of CT angiography is important in minimizing interpretation errors.
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