多层CT血管造影对急性缺血性脑血管病变的诊断作用

Multi-slice CT Angiography in the Evaluation of Patients with Acute Ischemia Cerebrovascular Disease

目的评价多层CT血管造影(MS CTA)对脑血管系统中急性动脉或静脉阻塞性病变的诊断作用。方法选择临床怀疑急性脑缺血性病变的病人38例(表现为大脑半球症状28例,椎基系统症状10例),怀疑有急性脑静脉(CVT)栓塞病人5例。其中5例做了磁共振血管造影MRA检查,6例经DSA检查。对全部病例颅内外脑血管系统的狭窄或闭塞进行观察分析,并与临床进行对比。结果43例中有41例MS CTA得到了可以达到诊断目的的高质量动脉和静脉图像,包括颈总动脉及其分支、颅内大动脉的第三段、硬膜窦、大脑内静脉。2例因假牙伪影致颈部血管显示不清。在所有影像和临床随访证实为非腔隙性脑梗死的23例中,MS CTA均看到了潜在的血管病变。怀疑脑静脉栓塞的病例中,2例经CTA证实有静脉栓塞,3例被排除。结论对于急性脑血管意外的病例,MS CTA是迅速和综合评价脑血管动静脉系统的有力手段。

Objective to evaluate the suitability of multi-slice CTA (MS-CTA) for the assessment of the arteriovenous CVS in patients with acute symptoms of either arterial or venous occlusive diseases.Methods Thirty-eight patients with clinically suspected acute cerebral ischaemia (hemispheric in 28 and vertebrobasilar in 10 patients) and 5 patients with suspected cerebral venous thrombosis (CVT) underwent CTA in a MS-CT scanner. In addition, magnetic resonance angiography(MRA) was performed in 5, and digital subtraction angiography(DSA) in 6 patients. All findings were reviewed for stenoses or occlusion of the extra and intracranial CVS and correlated with the clinical outcome. Results In 41 of 43 patients, MS-CTA extra- and intracranial CVS yielded images of diagnostic quality with comprehensive visualization of the arterial and venous CVS including the cervical carotid bifurcation, the third segment of the major cerebral arteries and the dural sinus as well as internal cerebral veins. In 2 patients, assessment of the carotid bifurcation was limited because of tooth artefacts. In all patients, in whom imaging and clinical follow-up proved a non-lacunar infarction (n=23), MS-CTA detected the underlying vascular pathology: Suspected CVT could be confirmed in 2 and ruled out in another 3 patients through MS-CTA. Conclusion Multi-slice CT angiography may be a new diagnostic tool for the rapid and comprehensive assessment of the arteriovenous CVS in patients with clinical signs of acute cerebrovascular diseases.