摘要：

 目的 探讨超高速螺旋CTA评价急诊出血型烟雾病患者病情严重程度和判断预后的临床价值。方法 经CT平扫疑似出血型烟雾病的187例患者均为2014年6月至2019年1月急诊病例，于脑出血急性期（<72h）经超高速螺旋CTA检查和图像后处理确诊，分别行内科保守治疗、血肿清除术或脑室外引流术，改良Rankin量表（mRS）和Glasgow预后分级（GOS）评价患者发病后1、3和6个月神经功能缺损程度和预后。结果 106例（56.68%）符合烟雾病影像学特征，表现为颈内动脉狭窄、闭塞，Willis环增粗，部分血管扩张明显，基底节区侧支血管明显增多，额颞叶交界区底部血管呈增多趋势，脑底部实质内细小、密集的烟雾状血管生成。与DSA相比，CTA诊断准确率为95.27%（155/161）、假阳性率为4.76%（3/63）、假阴性率为3.06%（3/98）。其中，84例CTA显示“粟粒征”阳性、103例“粟粒征”阴性，“粟粒征”阳性组患者发病后1、3和6个月mRS评分高于（P=0.000）、GOS评分低于（P=0.000）“粟粒征”阴性组；随着随访时间的延长，两组患者mRS评分逐渐降低（均P=0.000）、GOS评分逐渐升高（均P=0.000）。结论 超高速螺旋CTA作为疑似出血型烟雾病的急诊辅助诊断方法，具有安全、便捷、诊断准确率高等优势，对判断预后也有一定指导意义。

关键词:  脑出血, 脑底异常血管网病, 计算机体层摄影血管造影术

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.

Key words:  Cerebral hemorrhage, Moyamoya disease, Computed tomography angiography