<原著論文>脳動脈瘤クリッピング術後評価における3D-CTAの意義 - 脳血管撮影,SSD画像およびVR画像3者の比較検討 -

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Purpose: To assess the significance of three-dimensional CT-angiography(3D-CTA) in detecting remnant necks after cerebral aneurysm clipping, 3D-CTAwas compared with intra-arterial digital subtraction angiography (IADSA).Materials and Methods: Fifty-nine patients (79 aneurysms) underwent bothIADSA and 3D-CTA after cerebral aneurysm clipping. A single detector spiral scannerwas used for 3D-CTA. Shaded surface display (SSD) and volume rendered (VR)images were produced from each data set. Two blinded observers independentlyevaluated the presence of remnant necks on SSD images, VR images and IADSA.Results jointly evaluated by three observers were applied as the gold standard to assessdiagnostic accuracy of each image. Diagnostic performance of each image was evaluatedusing receiver operating characteristic (ROC) analysis.Results: Mean sensitivity and specificity of SSD images for detecting remnant neckswere 50.0% and 74.2%, respectively. VR images displayed a mean sensitivity andspecificity of 63.3% and 82.8%, respectively. IADSA demonstrated a mean sensitivityand specificity of 93.3% and 92.2%, respectively. Under ROC analysis, IADSA displayedexcellent diagnostic performance (mean Az [area under ROC curve] =0.97).While 3D-CTA demonstrated good diagnostic performance (0.68 and 0.76 for SSD andVR, respectively), it was significantly inferior to IADSA (P <.001). Mean Az for VRimaging was significantly superior to that for SSD imaging (P <.001) .Conclusion: Following clipping surgery for cerebral aneurysms, 3D-CTA, andparticularly VR imaging, is useful for postoperative evaluation. As a noninvasivealternative, 3D-CTA could be recommended for routine use. However, IADSA shouldstill be performed when 3D-CTA yields uncertain results.
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<原著論文>脳動脈瘤クリッピング術後評価における3D-CTAの意義 - 脳血管撮影,SSD画像およびVR画像3者の比較検討 -

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