脑动脉狭窄的影像诊断：CT血管成像与磁共振血管成像的对照性研究.docVIP

???? 脑动脉狭窄的影像诊断：CT血管成像与?磁共振血管成像的对照性研究 ???? ????［摘要］　目的　对CT血管成像(CTA)与磁共振血管成像(MRA)进行对照性研究，评价CTA诊断脑血管狭窄性病变的临床意义。方法　34例患者均行CTA及MRA检查，其中5例同时行DSA检查。分析每个病人血管影像相应部位不同影像方法显示的程度与部位分布，并用双盲法验证。结果　34例病人MRA显示血管狭窄共100处，其中1°～2°16处，10处CTA相应部位显示无狭窄；3°～4°84处，49处相应部位CTA显示无狭窄，11处CTA相应部位显示为1°～2°狭窄；3处MRA无狭窄而CTA显示狭窄。5例行DSA检查患者的MRA显示脑动脉狭窄23处，其中仅7处DSA显示相应部位血管狭窄，MRA假阳性率69.6%，过度诊断率95.7%；CTA显示动脉狭窄7处，与DSA相应血管部位表现相同，未出现假阳性。作者及双盲法的统计结果的差异无显著性(P=0.257列联表确切概率法)。结论　CTA显示脑动脉狭窄较MRA更接近实际情况，影像更为可靠。进一步改进影像编辑方法后CTA可为临床怀疑动脉狭窄或其他病变更为可靠的影像筛选方法。　　［关键词］　脑　　血管　　狭窄　　诊断　　CT血管成像　　MR血管成像 Intracranial Arterial Stenosis:a Comparative Study of CTA and MRAPeng Ying,Tang Guangjian,Wang YishengDepartment of Radiology ,The First Clinical Hospital of Beijing Medical University (Beijing 100034) ［Abstract］　Purpose　To prospectively study the CT angiography(CTA) and MR angiography (MRA) of intracranial vessels comparatively and evaluate CTA in the diagnosis of cerebrovascular stenosis.Methods　Thirty-four patients were studied with CTA and MRA,Five patients underwent DSA at the same time.The seriousness and location of the stenoses shown by CTA,MAR and/or DSA in the same patient were analyzed respectively and a double-blind analysis of these data was taken for testing the result.Results　100 stenoses were considered by MRA of the 34 cases,16 were depicted as stenoses of Grade One to Two,but 10 of them as normal on CTA;84 as Grade Three to Four,but 49 as normal on CTA and 11 as stenoses of Grade One to Two on CTA;3 as normal on MRA but as stenoses on CTA.23 stenoses were considered by MRA but only seven were as stenoses on DSA of the five cases.The rate of false positiveness of MRA was 69.6% and the rate of overestimation was 95.7%.Seven stenoses were considered on CTA and no false positiveness was found.Differences among the author and the two viewers of the double blind test were not significant (P=0.257).Conclusion　CTA is much more closer to the real situations of the stenoses of the intacranial vessels and more reliable