摘要： 目的 探讨4维CT血管造影（4D-CTA）在颅内动脉瘤诊断中的应用价值。方法 收集本院2017年5月至2018年12月收治的颅内动脉瘤患者100例为研究对象。采用4D-CTA扫描方案的50例患者作为研究组，根据颅内动脉瘤是否破裂进一步分为破裂组（n=32）和非破裂组（n=18）。采用3D-CTA扫描方案的50例患者作为对照组。比较研究组、对照组主观图像质量评分，颈内动脉（ICA）、大脑中动脉（MCA）、脑实质CT值，信噪比（SNR），噪声比（CNR），辐射剂量。比较破裂组、非破裂组患者动脉瘤的4D-CTA影像学特征。对研究组患者4D-CTA各检测参数进行受试者工作特征（ROC）曲线及最佳临界点分析。结果 研究组CT剂量指数、剂量长度乘积、辐射有效剂量均明显低于对照组，差异均有统计学意义（均P<0.01）；研究组与对照组主观图像质量评分、SNR、CNR值比较无统计学差异（均P>0.05）。破裂组患者瘤颈宽、瘤体高度、瘤体长度、动脉瘤宽颈、瘤体高度/瘤颈宽、瘤体长径/载瘤动脉直径、瘤体宽颈/瘤颈宽均明显高于非破裂组，差异有统计学意义（均P<0.05）。破裂组存在子囊比率、形态不规则比率、有搏动点比率均明显高于非破裂组，差异有统计学意义（均P<0.05）。破裂组和非破裂组动脉瘤位置比较有统计学差异（P<0.01）。ROC曲线结果显示，瘤体高度/瘤颈宽、瘤体长径/载瘤动脉直径、瘤体高度、动脉瘤宽颈、瘤体宽颈/瘤颈宽、瘤体长度在颅内动脉瘤破裂的诊断中均有统计学意义（P<0.05或P<0.01）。结论 4D-CTA能在低浓度对比剂、低辐射剂量条件下观察到颅内动脉瘤的静态特征（大小、部位、子瘤、形态等），也能体现动脉瘤壁的运动情况（搏动点），使对异常波动点的观测成为可能。4D-CTA脑血管成像技术对破裂动脉瘤的诊断具有重要的临床意义。

4D-CTA在颅内动脉瘤诊断中的应用价值

蒋孝先, 罗光华, 周飞, 刘文洪

南华大学附属第一医院放射科, 湖南 衡阳 421001

收稿日期:2019-04-11出版日期:2020-04-30发布日期:2020-04-18
通讯作者:罗光华E-mail:1579839814@qq.com
作者简介:蒋孝先(1982-),女,主治医师,硕士.
基金资助:衡阳市科学技术发展计划项目（2017KJ315）


关键词: 4维CT血管造影, 颅内动脉瘤, 诊断, 辐射, 图像质量
Abstract: Objective This study aimed to explore the application value of four-dimensional computed tomography angiography(4D-CTA) in the diagnosis of intracranial aneurysm. Methods A total of 100 patients who were admitted to our hospital and presented with intracranial aneurysm between May 2017 to December 2018,were recruited for the study. The patients were separated into the experimental and control groups. Patients in the experimental group,further divided into the rupture group (n=32) and the non-rupture group (n=18),underwent 4D-CTA scanning while patients in the control group (n=50) underwent 3D-CTA scanning. Subjective image quality scores,internal carotid artery (ICA),middle cerebral artery (MCA),CT value of brain parenchyma,signal to noise ratio (SNR),carrier noise ratio (CNR),and radiation dose were compared between the groups. Aneurysmal characteristics between the rupture and non-rupture groups were compared using the 4D-CTA imaging. Analysis of the receiver operating characteristic (ROC) curve and the optimal critical point were performed in the experimental group. Results There was no significant difference in the subjective image quality score,SNR,and CNR between the two groups (P>0.05). The CT dose index,dose length product,and effective radiation dose were significantly lower in the experimental group compared with that in the control group (P<0.01). Tumor related parameters of the ruptured group were significantly higher compared with that of the non-ruptured group (P<0.05). The rate of secondary tumor,irregular shape,and pulsatile point in the ruptured group were also significantly higher compared with that of the non-ruptured group (P<0.05). There were statistically significant differences in aneurysm location between the two groups (P<0.01). The ROC curve results showed that tumor related parameters were statistically significant in the diagnosis of intracranial aneurysm rupture (P<0.05 or P<0.01). Conclusion Under low concentration contrast agent and low radiation dose conditions,4D-CTA can be used to observe the static characteristics and movement of the aneurysmal wall of intracranial aneurysm patients. Thus,observation of abnormal fluctuation points can be possible. These findings can significantly impact clinical diagnosis of a ruptured aneurysm.
Key words: four-dimensional computed tomography angiography, intracranial aneurysm, diagnosis, radiation, image quality
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