三维CT血管造影在诊断脑梗死中的应用

Application for diagnosing cerebral infarctions with three-dimensional CT angiography

目的:探讨多层面螺旋CT三维血管造影(3D-CTA)诊断脑梗死的临床价值。方法:26例脑梗死病例,均经普通CT及/或MRI检查确诊。Toshiba多层面螺旋CT-AQUILION采集原始数据,扫描速度0.5秒/每转,层厚1.0mm,螺距0.5;对比剂安其格纳芬:1.0～2.0ml/kg体重,注射速度2.5～3.0ml/s,延迟时间:15～23秒;SGIO2图像后处理工作站,后处理软件为:ALATOVIEW版本1.21;采用多平面重建(MPR)、最大密度投影(MIP)、遮盖容积重建(SVR)、CT仿真内窥镜(Fly-around/Fly-through)4种后处理技术。所得图像分别由三位放射科医生和二位神经内科医生评价。结果:3D-CTA检出大脑中动脉闭塞及狭窄17个,大脑后动脉闭塞及狭窄2个,椎动脉狭窄1个,显示Willis环周围的血管及与颅骨的清晰、确切关系。Fly-through观察血管壁未发现1例血栓形成及钙化,动脉壁几乎均是光滑的。结论:3D-CTA诊断脑梗死快速、无创、直观,是辅助诊断脑梗死的重要工具。

Objective:To evaluate the clinical value of multi-slice helical CTthree-dimensional angiography as an assistant method for diagnosing cerebral infarctions.Methods:We studied26patients with cerebral infarctions.All these patients underwent3D-CTA.Original data was acquired by Multi-slice helical CT-QUILION(Toshiba):scan speed0.5s/rot,image slice thickness1.0mm,helical pitch0.5.Contrast media(Angiografin)was injected intravenously(1.0-2.0ml/kg)at speed of2.5～3.0ml/s,delay time was15～23s,reconstruction interval0.5mm,reconstruction slice thickness1.0mm.Source images were processed using a workstation SGIO2,images post-processing software was ALAˉTOVIEW,Version1.21.The reconstructed images were then processed into multi-planar reformation(MPR)and maximal intensity projection(MIP)and shaded volume rendering(SVR)and Fly-around/Fly-through images.Images of3D-CTA were analysed by3radiologists and2neurologists.Results:17middle cerebral arteries occlusion or stenosis were detected,and2posterior cerebral arteries occlusion or stenosis were detected.1vertebral artery stenosis was detected by3D-CTA.Large vessel occlusion and the relationship between the circle-of-Willis and surrounding structures was clearly and displayed surely.Thrombus and calcification were not found on the vessel wall by fly-through.The artery wall was almost smooth.Conclusion:3D-CTA is a rapid and noninvasive and visual method for detecting cerebral infarctions.3D-CTA may be a important assistant tool for diagnosing cerebral infarctions.