超高分辨率光子计数CTA用于血流导向装置术后颅内动脉瘤随访评估的初步体验
这项前瞻性研究连续纳入47例血流导向装置治疗的颅内动脉瘤患者，比较超高分辨率（UHR）与标准分辨率（SR）光子计数CT血管成像（PCCTA）及DSA在术后随访中的评估效能。结果显示UHR-PCCTA诊断信心更高（中位5 vs 4，P<0.05），与即刻DSA相比对瘤颈覆盖、壁贴壁、支架变形、分支血管受累及动脉瘤闭塞的诊断准确率分别为93.3%、100.0%、93.8%、93.3%和88.2%。UHR-PCCTA在FD术后评估中具有高可靠性和诊断准确性。
要点
- UHR-PCCTA诊断信心显著高于SR-PCCTA，阅片时优先选用UHR重建。
- UHR-PCCTA评估支架壁贴壁准确率达100.0%，瘤颈覆盖和分支血管受累均为93.3%。
- UHR-PCCTA对动脉瘤闭塞的诊断准确率为88.2%，需结合DSA验证。
关键影像表现/征象
- UHR-PCCTA诊断信心中位数为5（IQR 5-5），高于SR-PCCTA的中位数4（IQR 4-5），P<0.05。
- UHR-PCCTA在动脉瘤和支架形态评估的读者间一致性κ为0.814-1.0，ICC为0.902-0.960。
- SR-PCCTA的读者间一致性κ为0.668-1.0，ICC为0.873-0.966。
- UHR-PCCTA评估内容涵盖动脉瘤大小、闭塞状态、瘤颈覆盖、壁贴壁、支架变形及分支血管受累。
诊断标准与关键数值
- 与即刻DSA相比，UHR-PCCTA诊断瘤颈覆盖准确率93.3%，壁贴壁100.0%，支架变形93.8%，分支血管受累93.3%，动脉瘤闭塞88.2%。
- 读者对各项评估采用Likert 1-5分评分。
临床应用与阅片要点
- FD术后随访阅片时优先采用UHR-PCCTA重建，以提高诊断信心和观察者间一致性。
- 报告应系统评估瘤颈覆盖、壁贴壁、支架变形、分支血管受累及动脉瘤闭塞状态。
- 对动脉瘤闭塞的判断准确率略低（88.2%），需警惕假阴性/假阳性，必要时结合DSA确认。
局限性
- 本研究为单中心前瞻性初步体验，样本量有限（47例患者、57个动脉瘤）。
- 原文未报告长期随访结果及辐射剂量等数据。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Accurate imaging follow-up after flow diverter (FD) treatment is essential, but digital subtraction angiography (DSA) is invasive and conventional CT lacks resolution. Photon-counting CT angiography (PCCTA) offers ultra-high resolution (UHR) and improved artifact reduction. This study compared UHR-PCCTA versus standard resolution (SR)-PCCTA and DSA for comprehensive post-FD assessment.
METHODS: This prospective study consecutively enrolled 47 participants treated with FD and subsequently underwent PCCTA with UHR and SR reconstructions between August 2023 and August 2024. Two readers independently analyzed images blindly, including aneurysm size, occlusion status, neck coverage, wall apposition, stent deformation, branch vessel with Likert-scale (1-5). Inter-rater reliability for both UHR and SR-PCCTA was assessed using the intraclass correlation coefficient (ICC) and weighted Cohen's kappa. Diagnostic performance of PCCTA within 1 month after FD was compared with that of immediate post-deployment DSA using confusion matrix.
RESULTS: Totally 47 participants with 57 intracranial aneurysms treated with 51 FD stents. UHR-PCCTA exhibited higher diagnostic confidence (median = 5, IQRs = 5-5) compared to SR-PCCTA (median = 4, IQRs = 4-5, P < 0.05). UHR-PCCTA demonstrated a trend toward higher inter-rater agreement (κ: 0.814-1.0; ICC :0.902-0.960) relative to SR-PCCTA (κ: 0.668-1.0; ICC: 0.873-0.966) among both aneurysm and stent morphology. Compared with immediate post-deployment DSA, UHR-PCCTA showed excellent diagnostic accuracy for aneurysm neck coverage (93.3%), wall apposition (100.0%), stent deformation (93.8%), branch vessel inclusion (93.3%), along with very-good accuracy for aneurysm occlusion (88.2%).
CONCLUSION: UHR-PCCTA demonstrates high reliability and diagnostic accuracy in the assessment of intracranial aneurysms following FD treatment. Its comprehensive imaging evaluation capability has the potential to inform clinical decision-making.
引用
- Li R, He N, Cui Y, et al. Ultra-high resolution Photon-Counting CTA for follow-up assessment of intracranial aneurysms after flow diverter: Initial experience. Eur J Radiol. 2026. PMID: 42070422. doi:10.1016/j.ejrad.2026.112893
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。