原发性蛛网膜下腔出血放射影像诊断的价值分析

The analysis of diagnostic value about clinical,laboratory,CT,MRA,DSA in primary subarachoid hemorrhage

目的探讨目前常用的原发性蛛网膜下腔出血(SAH)诊断方法的价值,为不同时期、不同病因的SAH提供临床最适宜的诊断顺序和手段。方法对122例确诊的SAH患者不同时期的临床、实验室、CT、MRA、DSA等结果进行回顾性分析,评价其阳性结果的敏感性并分析阴性结果的原因。结果突发的头痛、呕吐、脑膜刺激征、眼底改变为SAH的最早期的临床表现;起病72h内腰穿的阳性率为100%,CT阳性率92%(112122),MRI、MRA病因诊断阳性率为45.55%(7090)。数字减影全脑血管造影病因诊断阳性率为70.83%(5172)(其中动脉瘤29例,动静脉畸形30例,硬脑膜动静脉瘘5例,血管炎2例,横窦血栓1例);脊髓MRI发现脊髓血管畸形2例。结论特征的临床表现及腰穿为急性期确诊SAH的首选;CT阴性不能排除SAH;DSA在病因诊断优于MRA;脊髓血管造影可发现头CT、MRA、DSA均阴性的病变。

Objective To investigate the value of various diagnostic methods used in subarachoid hemorrhage(SAH) for providing the best chioce of method at different periods and for different etiology. Methods (The clinical) information and results of lumbar puncture, CT, MRA, DSA were analyzed retrospectively in 122 patients suffering from SAH at different periods in order to investigate the sensitivity of positive findings and analyze the cause of negative findings. Results Acute headache,vomit,meningeal irritation sign,the change of eyeground were the useful early clinical manifestation .The positive rate of lumbar puncture was 100% and the positive rate of CT was 92% within 72 hours after onset. The positive findings of MRI, MRA were 45.55% in etiological diagnosis, while those of DSA were 70.83% (including 28 cases of aneurysm, 30 of arteriovenous malformation AVM, 5 of dural arteriovenous fistula, 2 of vasculitis, 1 of lateral sinus thrombus). MRI detected vascular malformation of spinal cord in 2 cases. Conclusion Specific symptom and lumbar puncture are the methods of choice for confirmation diagnosis in patients suffering from SAH within the acute period . Negative result in CT can't rule out SAH. DSA is better than MRA in etiological diagnosis. The actual result etiology could be revealed by MR or spinal cord angiography when all results of CT, MRA, and DSA are normal.;