تعیین و مقایسه‌ی یافته‌های سی‌تی آنژیوگرافی و آنژیوگرافی مغزی در بیماران مبتلا به خونریزی ساب عنکبوتیه

نوع مقاله : Original Article(s)

نویسندگان

1 دستیار تخصصی، گروه رادیولوژی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران

2 استادیار، گروه رادیولوژی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران

10.48305/jims.v42.i765.0325

چکیده

مقاله پژوهشی




مقدمه: این مطالعه با هدف مقایسه‌ی یافته‌های سی‌تی آنژیوگرافی (Computed tomography angiography) CTA و آنژیوگرافی 4 رگ در بیماران مبتلا به خونریزی ساب آراکنوئید (Subarachnoid hemorrhage) SAH انجام شد.
روش‌ها: این مطالعه‌ی مقطعی گذشته‌نگر به منظور مقایسه‌ی یافته‌های CTA و آنژیوگرافی 4 رگ در بیماران مبتلا به SAH انجام شد. داده‌ها از گزارش‌های رادیولوژی بیمارانی که تحت CTA و آنژیوگرافی مغزی قرار گرفتند، استخراج گردید.
یافته‌ها: تعداد 60 بیمار مبتلا به SAH شامل 32 زن (53/3 درصد) و 28 (46/7 درصد) مرد وارد مطالعه گردیدند. میانگین سنی شرکت‌کنندگان 9/6 ± 59/3 سال بوده است. 22 بیمار (37 درصد) دارای یافته‌های غیر طبیعی شامل 3 بیمار (13/7 درصد) دچار AVM و 86/3 درصد دچار آنوریسم مغزی بودند. از میان 22 بیمار، آنوریسم در 16 بیمار (72/7 درصد) توسط روش CTA تشخیص داده شد. داده‌ها نشان داد که روش CTA با دقت 81/8 درصد، حساسیت 72/7 درصد و اختصاصیت 100 درصد، قادر به شناسایی ناهنجاری‌های عروقی در بیماران مبتلا به SAH خودبخودی در مقایسه با روش آنژیوگرافی 4V می‌باشد. سطح زیر منحنی برای تشخیص آنوریسم و AVM توسط روش CTA، 0/632 (67-91 : CI 95%) (0/028 = P) بوده است. ارزش اخباری مثبت و منفی روش CTA برای تشخیص آنوریسم به ترتیب 10/9 و 83/6 بود. متوسط اندازه‌ی آنوریسم به طرز معنی‌داری در روش CTA کمتر از روش آنژیوگرافی 4V می‌باشد (5/44 در برابر 7/11 میلی‌متر) (0/04 = P).
نتیجه‌گیری: نتایج مطالعه‌ی حاضر نشان داد که روش CTA دقت و اختصاصیت قابل قبولی در تشخیص آنوریسم و AVM در SAH خودبخودی در مقایسه با روش آنژیوگرافی 4V دارد.

تازه های تحقیق

مژگان صامت زاده: PubMed, Google Scholar 

مریم طیبی: Google Scholar

عظیم معتمد فر:  Google Scholar

نسترن مجدی نسب:  Google Scholar

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Determining and Comparing the Findings of CT Angiography and Cerebral Angiography in Patients with Subarachnoid Hemorrhage

نویسندگان [English]

  • Maryam Tayebi 1
  • Azim Motamed Far 2
  • Mohammad Momen Gharibvand 2
  • Nastaran Majdinasab 2
  • Mojgan Sametzadeh 1
1 Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Assistant Professor, Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
چکیده [English]

Background: This study was conducted to compare the findings of computed tomography angiography (CTA) and 4-vessel Angio angiography (4V) in patients with subarachnoid hemorrhage (SAH).
Methods: This retrospective cross-sectional study was conducted to compare the findings of CTA and cerebral angiography in patients with SAH. Data were extracted from radiology reports of patients who underwent CTA and cerebral angiography.
Findings: We included 60 patients with SAH, comprising 32 women (53.3%) and 28 men (46.7%). The mean age of the participants was 59.3 ± 9.6 years. 22 patients (37%) had abnormal findings, including three patients (13.7%) with AVM and 86.3% with aneurysm. Among 22 patients, the aneurysm was diagnosed in 16 patients (72.7%) by CTA method. The data indicates that the CTA method has an 81.8% accuracy, 72.7% sensitivity, and 100% specificity in identifying vascular abnormalities in patients with spontaneous SAH compared to the 4V angiography method. The area under the curve for diagnosing aneurysm and AVM by CTA method was 0.632 (91-67: 95% CI (P = 0.028). The positive and negative predictive values of the CTA method for aneurysm diagnosis were 10.9 and 83.6, respectively. The mean size of the aneurysm was significantly lower in CTA than in 4V angiography (5.44 vs. 7.11 mm) (P = 0.04).
Conclusion: The results of the present study showed that the CTA method has acceptable accuracy and specificity in diagnosing aneurysm and AVM in spontaneous SAH compared to the 4V angiography method.

کلیدواژه‌ها [English]

  • Aneurysm
  • Angiography
  • Computed tomography angiography
  • Subarachnoid hemorrhage

مراجع

  1. Nicholson P, O’Hare A, Power S, Looby S, Javadpour M, Thornton J, et al. Decreasing incidence of subarachnoid hemorrhage. J Neurointerv Surg 2019; 11(3): 320-2.
  2. Zerega Ruiz M, Müller Campos K, Rivera Miranda R, Bravo Grau S, Cruz Quiroga JP. Hemorragia Subaracnoídea no Traumática con Angiografía por tomografía computada inicial “Negativa. Rev Chil Radiol 2018; 24(3): 94-104.
  3. Etminan N, Chang H-S, Hackenberg K, De Rooij NK, Vergouwen MD, Rinkel GJ, et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol 2019; 76(5): 588-97.
  4. Lindbohm JV, Kaprio J, Jousilahti P, Salomaa V, Korja M. Sex, smoking, and risk for subarachnoid hemorrhage. Stroke 2016; 47(8): 1975-81.
  5. Lindbohm J, Korja M, Jousilahti P, Salomaa V, Kaprio J. Adverse lipid profile elevates risk for subarachnoid hemorrhage: A prospective population-based cohort study. Atherosclerosis 2018; 274: 112-9.
  6. Heit JJ, Pastena GT, Nogueira RG, Yoo AJ, Leslie-Mazwi TM, Hirsch JA, et al. Cerebral angiography for evaluation of patients with CT angiogram-negative subarachnoid hemorrhage: an 11-year experience. AJNR Am J Neuroradiol 2016; 37(2): 297-304.
  7. Uysal E, Yanbuloglu B, Ertürk M, Kilinç BM, Basak M. Spiral CT angiography in diagnosis of cerebral aneurysms of cases with acute subarachnoid hemorrhage. Diagn Interv Radiol 2005; 11(2): 77-82.
  8. Mkhize NN, Mngomezulu V, Buthelezi TE. Accuracy of CT angiography for detecting ruptured intracranial aneurysms. SA Journal of Radiology 2023; 27(1): 2623.
  9. Allen JW, Prater A, Kallas O, Abidi SA, Howard BM, Tong F, et al. Diagnostic performance of computed tomography angiography and computed tomography perfusion tissue time‐to‐maximum in vasospasm following aneurysmal subarachnoid hemorrhage. J Am Heart Assoc 2022; 11(1): e023828.
  10. Westerlaan HE, van Dijk JMC, Jansen-van der Weide MC, de Groot JC, Groen RJ, Mooij JJA, et al. Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis—systematic review and meta-analysis. Radiology 2011; 258(1): 134-45.
  11. Harifi M, Digaleh H, Naeemi A, Amirjamshidi A. Intracranial subarachnoid hemorrhage with negative cerebral angiogram, how to deal with? report of SAH due to spinal hemangioblastoma and review of literature [in Persian]. Iranian Journal of Surgery 2020; 28(1-2): 71-8.
  12. Waqas M, Chin F, Rajabzadeh-Oghaz H, Gong AD, Rai HH, Mokin M, et al. Size of ruptured intracranial aneurysms: a systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162(6): 1353-62.
  13. Jaja BN, Cusimano MD, Etminan N, Hanggi D, Hasan D, Ilodigwe D, et al. Clinical prediction models for aneurysmal subarachnoid hemorrhage: a systematic review. Neurocrit Care 2013; 18(1): 143-53.
  14. Greving JP, Wermer MJ, Brown RD, Morita A, Juvela S, Yonekura M, et al. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 2014; 13(1): 59-66.
  15. Detmer FJ, Chung BJ, Jimenez C, Hamzei-Sichani F, Kallmes D, Putman C, et al. Associations of hemodynamics, morphology, and patient characteristics with aneurysm rupture stratified by aneurysm location. Neuroradiology 2019; 61(3): 275-84.
  16. Duan Z, Li Y, Guan S, Ma C, Han Y, Ren X, et al. Morphological parameters and anatomical locations associated with rupture status of small intracranial aneurysms. Sci Re 2018; 8(1): 6440.
  17. Feng X, Zhang B, Guo E, Wang L, Qian Z, Liu P, et al. Bifurcation location and growth of aneurysm size are significantly associated with an irregular shape of unruptured intracranial aneurysms. World Neurosurgery 2017; 107: 255-62.
  18. Bakar IA, Shuaib IL, Ariff ARM, Naing NN, Abdullah JM. Diagnostic cerebral angiography in spontaneous intracranial haemorrhage: a guide for developing countries. Asian J Surg 2005; 28(1): 1-6.
  19. Khaghani E, Ghenaati H, Neshan E, Shakiba M. Evaluation of angiographic findings of flat panel and conventional methods in patients with Subarachnoid Hemorrhage (SAH) referred to Imam Khomeini Radiology Center from 2006-2007 [in Persian]. Medical Sciences 2009; 19(4): 274-9.
  20. Almandoz JD, Schaefer P, Forero N, Falla J, Gonzalez R, Romero J. Diagnostic accuracy and yield of multidetector CT angiography in the evaluation of spontaneous intraparenchymal cerebral hemorrhage. AJNR Am J Neuroradiol 2009; 30(6): 1213-21.
  21. Laissy J-P, Normand G, Monroc M, Duchateau C, Alibert E, Thiebot J. Spontaneous intracerebral hematomas from vascular causes: predictive value of CT compared with angiography. Neuroradiology 1991; 33(4): 291-5.
  22. Loes DJ, Smoker WR, Biller J, Cornell SH. Nontraumatic lobar intracerebral hemorrhage: CT/angiographic correlation. AJNR Am J Neuroradiol 1987; 8(6): 1027-30.
  23. Cho S-h, Lee J-y, Ryu K-h, Suh DC. Diagnosis of cerebral aneurysm via magnetic resonance angiography screening: emphasis on legal responsibility increases false positive rate. Neurointervention 2018; 13(1): 48-53.
  24. Mohan M, Islim A, Dulhanty L, Parry-Jones A, Patel H. CT angiogram negative perimesencephalic subarachnoid hemorrhage: is a subsequent DSA necessary? A systematic review. J Neurointerv Surg 2019; 11(12): 1216-21.
  25. Teksam M, McKinney A, Casey S, Asis M, Kieffer S, Truwit CL. Multi-section CT angiography for detection of cerebral aneurysms. AJNR Am J Neuroradiol 2004; 25(9): 1485-92.
  26. . Khaghani E, Firouz nia K, Ghenaati H, Neshan E, Shakiba M. Evaluation of angiographic findings of flat panel and conventional methods in patients with Subarachnoid Hemorrhage (SAH) referred to Imam Khomeini Radiology Center from 2006-2007 [in Persian]. Medical ScienceS 2009; 19(4): 274-9.
  27. Firooznia K, Ghenaati H, Shakiba M. Evaluation of brain angiographic findings and epidemiologic characteristics in subarachnoid haemorrhage cases [in Persian]. Tehran Univ Med J 2004; 62(8): 649-57.
  28. Ramnarayan R, Anto D, Alapatt J. Aneurysmal subarachnoid hemorrhage: Geography has a role. Asian J Neurosurg 2018; 13(03): 669-73.
  29. Schertz M, Mehdaoui H, Hamlat A, Piotin M, Banydeen R, Mejdoubi M. Incidence and mortality of spontaneous subarachnoid hemorrhage in Martinique. PLoS One 2016; 11(5): e0155945.
مجله دانشکده پزشکی اصفهان
دوره 42، شماره 765
هفته 1، تیر
خرداد و تیر 1403
صفحه 325-332

فایل ها

سابقه مقاله

  • تاریخ دریافت: 23 فروردین 1402
  • تاریخ بازنگری: 31 خرداد 1403
  • تاریخ پذیرش: 13 مرداد 1403

هم رسانی

ارجاع به این مقاله

آمار