目的：探讨基于320排容积CT灌注检查的动态血管成像（CTPa）对颅内动静脉分流性疾病的临床应用价值。方法：回顾性分析26例经CTPa检查诊断为颅内动静脉分流性疾病患者的影像学资料。以时间为序列进行多时相动态观察，记录病灶的部位、大小及血管构筑特点。其中17例患者行DSA检查，CTPa与DSA结果对照，分析两者诊断一致性。结果：26例患者包括动静脉畸形18例、动静脉瘘8例。CTPa能够明确病灶血管巢及瘘口的特点，显示供血动脉、引流静脉的解剖细节及血流动力学情况。17例患者的CTPa与DSA诊断结果一致，但CTPa漏诊3例动静脉畸形病灶的1根供血动脉（1/21）及3根引流静脉（3/23）。结论：CTPa能够准确诊断颅内动静脉分流性疾病，并反映其动静脉短路的病理特点，但对于细小结构的显示不及DSA。CTPa对颅内动静脉分流性疾病的诊断具有重要的临床应用价值。
Abstract
Objective: To explore the clinical application value of CT perfusion-derived arteriograms(CTPa) in cranial arteriovenous shunting lesions. Methods: Twenty-six cases, diagnosed of cranial arteriovenous shunting lesions by CTPa were included in this retrospective study. The location, size and angioarchitecture of the lesions were analyzed from the CTPa images. Using DSA images as the gold standard, the diagnostic and following-up accuracy of CTPa were evaluated in 17 cases. Results: There were 18 arteriovenous malformation cases and 8 arteriovenous fistula cases. CTPa could clearly show the angioarchitecture details of the lesions, including location, feeding arteries, draining veins and dynamic blood flow information. The diagnostic results of CTPa in 17 cases were consistent with those of DSA, but CTPa missed 1(1/21) feeding artery and 3(3/23) draining veins in three cases. Conclusion: Although some fine angioarchitectural details were missed when compared to DSA, CTPa was sufficiently accurate to diagnose the shunt. CTPa can be a valuable adjunct in the diagnosis of cranial arteriovenous shunting lesions.
关键词
颅内动静脉疾病 /
体层摄影术 /
螺旋计算机 /
血管造影术 /
数字减影
Key words
Intracranial arteriovenous malformations /
Tomography, spiral computed /
Angiography, digital subtraction
中图分类号：
Ｒ743.4
Ｒ814.42
Ｒ814.43
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Osborn AO. 脑血管造影诊断学[M]. 李松年，译. 北京：中国医药科技出版社，2000.
[2]Mohr JP, Kejda-Scharler J, Pile-Spellman J. Diagnosis and treatment of arteriovenous malformations[J]. Curr Neurol Neurosci Rep, 2013, 13(2): 324.
[3]Hanson EH, Roach CJ, Ringdahl EN, et al. Developmental venous anomalies: appearance on whole-brain CT digital subtraction angiography and CT perfusion[J]. Neuroradiology, 2011, 53(5): 331-341.
[4]Menzel HG, Schibilla H, Teunen D. Guidelines on radiation dose on the patient[J]. Eur Guidelines Quality Criteria Comput Tomogr, 2006, 1(1): 32-33.
[5]Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment[J]. J Neurosurg, 1995, 82(2): 166-179.
[6]Barrow DL, Spector RH, Braun IF, et al. Classification and treatment of spontaneous carotid-cavernous sinus fistulas[J]. J Neurosurg, 1985, 62(2): 248-256.
[7]Willinsky RA, Taylor SM, TerBrugge K, et al. Neurologic complications of cerebral angiography: prospective analysis of 2899 procedures and review of the literature[J]. Radiology, 2003, 227(2): 522-528.
[8]Gross BA, Frerichs KU, Du R. Sensitivity of CT angiography, T2-weighted MRI, and magnetic resonance angiography in detecting cerebral arteriovenous malformations and associated aneurysms[J]. J Clin Neurosci, 2012, 19(8): 1093-1095.
[9]Lv X, Wu Z, Jiang C, et al. Angioarchitectural characteristics of brain arteriovenous malformations with and without hemorrhage[J]. World Neurosurg, 2011, 76(1-2): 95-99.
[10]Abla AA, Rutledge WC, Seymour ZA, et al. A treatment paradigm for high-grade brain arteriovenous malformations: volume-staged radiosurgical downgrading followed by microsurgical resection[J]. J Neurosurg, 2015, 122（2）: 419-432.
[11]张英俊，出良钊，余晖. 四维CT血管造影在脑动静脉畸形诊断中的应用[J]. 中华神经外科杂志，2014，30（9）：880-883.
[12]田冰，陆建平，许兵，等. 硬脑膜动静脉瘘：4D CTA和DSA在诊断与分型中的对照研究[J]. 影像诊断与介入放射学，2014，23（1）：3-6.
[13]Willems PW, Brouwer PA, Barfett JJ, et al. Detection and classification of cranial dural arteriovenous fistulas using 4D-CT angiography: initial experience[J]. AJNR, 2011, 32(1): 49-53.
[14]郭漾，郭安齐，葛英辉，等. 64层螺旋CT脑灌注间隔轴扫模式降低扫描行性研究[J]. 中华放射学杂志，2009，43（12）：1243-1246.
[15]Kim DJ, Krings T. Whole-brain perfusion CT patterns of brain arteriovenous malformations: a pilot study in 18 patients[J]. AJNR, 2011, 32(11): 2061-2066.
