Application analysis of ultra-high-speed spiral CT angiography in hemorrhagic moyamoya disease

Abstract

Objective To explore the application value of ultra-high-speed spiral CT angiography (CTA) in the assessment and prognosis of hemorrhagic moyamoya disease (MMD) in emergency department. Methods A total of 187 patients with CT scanning suspected hemorrhagic MMD were all from emergency department from June 2014 to January 2019, and were diagnosed in acute stage (< 72 h) by ultra-high-speed spiral CTA examination and post-image treatment. Internal medicine conservative treatment, hematoma removal or extra ventricular drainage (EVD) were used respectively. The level and prognosis of neurofunctional impairment at 1, 3 and 6 months after onset of patients were evaluated with modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS). Results One hundred and six cases (56.68%) conformed to the imaging characteristics of MMD, showing intra-cervical artery stenosis or obliteration, Willis ring thickened, partial vascular obviously dilated, significantly increased collateral vessels in basal ganglion region, increasing blood vessels at the base of the junction of frontal-temporal lobe, occurrence of small, dense smoke-like angiogenesis at the brain bottom. Compared with DSA, CTA diagnosis accuracywas 95.27% (155/161), false positive rate was 4.76% (3/63), and false negative rate was 3.06% (3/98). Among them, there were 84 cases of CTA showed "millet sign" were positive, and 103 cases were negative. The "millet sign" positive group after onset of 1, 3 and 6 months the mRS score was higher (P = 0.000) and GOS score was lower than those in "millet sign" negative group (P = 0.000). The mRS score of 2 groups decreased gradually (P = 0.000, for all) and the GOS score gradually increased (P = 0.000, for all). Conclusions Ultra-high-speed spiral CTA assisted in the diagnosis of suspected hemorrhagic MMD patients in emergency apartment is safe and convenient with high diagnostic accuracy, and has a certain guiding significance for prognostic assessment.

DOI:10.3969/j.issn.1672-6731.2019.09.008