摘要： 研究背景 目前尚无研究显示64层螺旋CT血管造影术（CTA ）和三维数字减影血管造影术（3D-DSA）诊断颅内动脉瘤的效能是否存在差异，本研究旨在评价64层螺旋CTA 对颅内动脉瘤的诊断价值。方法 分别以64层、64排、CT、颅内动脉瘤、脑动脉瘤、蛛网膜下腔（隙）出血等词组作为检索词，检索荷兰医学文摘（EMBASE）、美国国家图书馆医学在线（MEDLINE）、Cochrane 图书馆、中国知网中国期刊全文数据库（CNKI）和万方数据知识服务平台学术期刊库，并辅助手工检索，收集以3D-DSA 为金标准的关于64层螺旋CTA 诊断颅内动脉瘤的中英文文献。采用诊断准确性研究质量评价工具和Meta-disc Version1.4 统计软件，对所纳入的临床试验进行质量评价和Meta分析。结果 共纳入4 项临床试验，经Meta分析显示，64层螺旋CTA 诊断颅内动脉瘤的灵敏度和特异度分别为97%（95%CI：0.950 ~0.980）和 91% （95%CI ：0.860 ~ 0.950），诊断优势比为269.640（95%CI ：137.250 ~ 529.720），汇总受试者工作特征曲线得出曲线下面积为0.993。结论 多层螺旋CTA 诊断颅内动脉瘤具有较高的敏感性和特异性，可以作为颅内动脉瘤的重要诊断方法。由于本研究所纳入的样本量较小，尚有待设计严谨且样本量更大的高质量研究进一步评价。

关键词: 体层摄影术, 螺旋计算机, 脑血管造影术, 颅内动脉瘤, Meta分析

Abstract: Background The difference of diagnostic accuracy of 64-slice computed tomography angiography (CTA) with 3D digital subtraction angiography (3D-DSA) in the detection of intracranial aneurysms is not clear yet. This study compares the diagnostic value of 64-slice CTA with 3D-DSA in the diagnosis of intracranial aneurysms via a Meta-analysis. Methods In this study, 64-slice, 64-row, CT, angiography, intracranial aneurysms, cerebral aneurysms, subarachnoid hemorrhage, etc. were used as key words, and searched in the electronic databases including Embase, MEDLINE, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang Data, assisted by manual searching, in order to retrieve articles both in English and Chinese that reported on comparisons of 64-slice CTA and 3D-DSA in the evaluation of suspected intracranial aneurysms. Meta-disc Version 1.4 was used for the Meta-analysis, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS) was applied to assess the quality of these research studies. Results Four clinical trials were selected. According to the Meta-analysis, the pooled sensitivity, specificity, diagnostic odds ratios (DOR) and summary receiver operating characteristics (SROC) area under curve (AUC) was 97% (95% CI: 0.950-0.980), 91% (95% CI: 0.860-0.950), 269.640 (95% CI: 137.250-529.720) and 0.993 respectively. Conclusion On the basis of Meta-analysis, 64-slice CTA has a high level of sensitivity and specificity for diagnoses of intracranial aneurysms and it can beused as an important examination tool in the diagnoses of intracranial aneurysms. Because the sample size of selected studies is small, it is necessary to perform well-designed and larger sample studies to further assess the diagnostic value of intracranial aneurysms by 64-slice CTA.

Key words: Tomography, spiral computed, Cerebral angiography, Intracranial aneurysm, Meta-analysis