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目的探讨64排螺旋CT血管成像(CTA)在脑动静脉畸形(AVM)术前评价的应用价值。方法 43例脑AVM术前均已完善CTA及数字减影血管造影(DSA)检查,参照Spetzler-Martin分级法,由放射科医师与神经外科医师共同阅片,以DSA为标准,应用CTA及DSA对其进行术前评价对比。结果 43例脑AVM均为单发;并发颅内出血急诊入院的25例(58%)。CTA与DSA对比,对脑AVM的分级结果一致,43例脑AVM中Ⅰ级2例(4%),Ⅱ级5例(12%),Ⅲ级21例(49%),Ⅳ级11例(26%),Ⅴ级4例(9%)。CTA与DSA对比,对脑AVM大小及引流静脉的检出结果一致,43例脑AVM中小型(<3 cm)7例,中型(3~6 cm)30例,大型(>6 cm)6例,引流静脉共检出71条。43例脑AVM中,应用DSA检出供血动脉共73条,敏感度和准确度均为100%,应用CTA检出供血动脉共65条,CTA对供血动脉的检出敏感度和准确度分别为89%、100%。结论应用CTA与DSA对脑AVM术前评价结果差异无统计学意义(P>0.05),CTA更为安全、方便,可作为首选方法。
Objective To investigate the value of 64-slice spiral CT angiography (CTA) in the preoperative evaluation of cerebral arteriovenous malformations (AVM). Methods 43 cases of brain AVM before surgery have been improved CTA and digital subtraction angiography (DSA) examination, the reference Spetzler-Martin grading method by radiologists and neurosurgical physicians to read the film, with DSA as the standard, the application of CTA and DSA Preoperative assessment of its comparison. Results All the 43 cases of AVM were single; 25 cases (58%) were complicated by intracranial hemorrhage. The results of CTA and DSA were consistent with those of AVM in brain. Among the 43 patients with brain AVM, grade Ⅰ was 2 (4%), grade Ⅱ 5 (12%), grade Ⅲ 21 (49%) and grade Ⅳ 11 26%), grade Ⅴ in 4 cases (9%). The results of CTA and DSA were consistent with the detection of brain AVM size and drainage veins. Among the 43 cases, there were 7 small and medium (<3 cm) brain AVMs, 30 medium (3 ~ 6 cm) and 6 large (> 6 cm) AVMs A total of 71 drainage veins were detected. In 43 cases of brain AVMs, 73 DSA-positive arteries were detected with sensitivity and accuracy of 100%. CTA was used to detect a total of 65 feeding arteries. The detection sensitivity and accuracy of CTA for the feeding arteries were 89%, 100%. Conclusions There is no significant difference between the preoperative evaluation of cerebral AVM using CTA and DSA (P> 0.05). CTA is more safe and convenient and can be used as the preferred method.