摘要： 目的 通过对比分析不同部位动脉瘤致蛛网膜下腔出血（SAH）的分布差异，探讨其CT分布对提高CTA颅内动脉瘤检出率的价值。方法 对2019年1月至2020年10月首都医科大学附属北京天坛医院收治的415例颅内动脉瘤致SAH患者行CT和CTA检查，比较不同部位动脉瘤致SAH的分布差异，对比分析高年资与低年资影像科医师对动脉瘤的检出率。结果 共415例患者计463个动脉瘤，包括Ⅰ类动脉瘤324个、Ⅱ类动脉瘤139个；其中责任动脉瘤415个，包括Ⅰ类动脉瘤295个、Ⅱ类动脉瘤120个。Ⅰ类动脉瘤出血主要分布于鞍上池（95.93%，283/295）、环池（90.17%，266/295）、纵裂（86.44%，255/295）、侧裂池（81.02%，239/295）、四叠体池（61.69%，182/295）和桥前池（50.85%，150/295），Ⅱ类动脉瘤出血主要分布于侧裂池（85.83%，103/120）、纵裂（80.83%，97/120）、鞍上池（78.33%，94/120）、环池（77.50%，93/120）、桥前池（67.50%，81/120）和四叠体池（66.67%，80/120）；Ⅰ类动脉瘤出血位于鞍上池［95.93%（283/295）对78.33%（94/120）；χ²=31.761，P=0.001］和环池［90.17%（266/295）对77.50%（93/120）；χ²=11.730，P=0.001］比例高于Ⅱ类动脉瘤，位于桥前池比例低于Ⅱ类动脉瘤［50.85%（150/295）对67.50%（81/120）；χ²=9.585，P=0.002）。低年资医师动脉瘤总体检出率（配对χ²检验：P=0.000）和Ⅱ类动脉瘤检出率（配对χ²检验：P=0.000）均低于高年资医师，经培训后Ⅱ类动脉瘤检出率接近高年资医师水平（配对χ²检验：P=0.146）。结论 颅内动脉瘤致SAH的CT分布具有规律性，有助于提高CTA颅内动脉瘤检出率。

关键词: 颅内动脉瘤, 蛛网膜下腔出血, 体层摄影术,螺旋计算机

Abstract: Objective To compare the CT location distribution of subarachnoid hemorrhage (SAH) caused by aneurysms at different locations, and to explore the value of CT hemorrhage distribution for improving the detection of aneurysms in CTA in diagnosing aneurysm. Methods Cerebral CT and CTA imaging of 415 patients with aneurysmal SAH from Beijing Tiantan Hospital, Capital Medical University from January 2019 to October 2020 were retrospectively analyzed. The differences of SAH location distribution caused by the aneurysms were compared, and the accuracy of aneurysm diagnosis between junior and senior radiologists were evaluated. Results A total of 415 patients had 463 aneurysms, including 324 type-Ⅰ aneurysms and 139 type-Ⅱ aneurysms. There were 415 responsible aneurysms, including 295 type-Ⅰ aneurysms and 120 type-Ⅱ aneurysms. SAH from type-Ⅰ aneurysms was mainly distributed in suprasellar cisterna (95.93%, 283/295), ambient cistern (90.17%, 266/295), longitudinal fissure (86.44%, 255/295), sylvian cistern (81.02%, 239/295), quadrigeminal cistern (61.69%, 182/295) and prepontine cistern (50.85%, 150/295). SAH from type-Ⅱ aneurysms was mainly distributed in sylvian cistern (85.83%, 103/120), longitudinal fissure (80.83%, 97/120), suprasellar cisterna (78.33%, 94/120), ambient cistern (77.50%, 93/120), prepontine cistern (67.50%, 81/120) and quadrigeminal cistern (66.67%, 80/120). The proportion of hemorrhage in suprasellar cisterna[95.93% (283/295) vs. 78.33% (94/120); χ²=31.761, P=0.001] and ambient cistern[90.17% (266/295) vs. 77.50% (93/120); χ²=11.730, P=0.001] was higher in type-Ⅰ aneurysms than that in type-Ⅱ aneurysms, and the proportion of hemorrhage in prepontine cistern was lower in type-Ⅰ aneurysms than that in type-Ⅱ aneurysms[50.85% (150/295) vs. 67.50% (81/120); χ²=9.585, P=0.002]. The overall rate of aneurysms detection and type-Ⅱ aneurysms detection in junior radiologists were lower than those in senior radiologists (paired χ² test:P=0.000, 0.000). After the training of SAH distribution, the junior radiologists increased their detection rate of type-Ⅱ aneurysms, and showed no significant difference compared with that of senior radiologists (paired χ² test:P=0.146). Conclusions The CT distribution of aneurysmal SAH has regularity. It's important to summarize the characteristics of SAH for improving the detection of aneurysms.

Key words: Intracranial aneurysm, Subarachnoid hemorrhage, Tomography, spiral computed