旋转式数字减影血管造影成像在颅内动脉瘤诊治中的应用

Diagnosis and treatment of intracranial aneurysms with three-dimensional reconstructed rotational digital subtraction angiography

目的探讨旋转式数字减影血管造影三维重建成像(3D-DSA)在诊断和治疗颅内动脉瘤中的价值。方法选择217例蛛网膜下腔出血患者,行常规DSA及3D-DSA检查。比较二者在显示动脉瘤的位置、大小、形态、瘤颈的宽窄及与载瘤动脉的空间关系中的作用。对证实为颅内动脉瘤的患者行介入栓塞或开颅夹闭术,应用3D-DSA对术后部分患者评价诊治效果。结果常规DSA发现139例(64.1%)153个动脉瘤;3D-DSA检出156例(71.9%)177个动脉瘤(检出率提高7.8%,P<0.01),其中有常规DSA漏诊的、直径<2mm的微小动脉瘤3个,发现5例常规DSA呈假阳性的患者;3D-DSA在显示动脉瘤瘤颈、瘤体形态及与载瘤动脉的空间关系方面明显优于常规DSA,差异有统计学意义(P<0.01)。弹簧圈栓塞97例,夹闭52例,保守治疗7例;应用3D-DSA随访术后84例介入栓塞和45例开颅夹闭患者,效果良好。结论3D-DSA技术显著提高动脉瘤检出率,能多角度立体显示动脉瘤大小、形态、瘤颈的宽窄及与载瘤动脉的空间关系,为治疗和评价诊治效果提供精确丰富的数据信息。

Objective To explore the value of three-dimensional reconstructed rotational digital subtraction angiography in diagnosing and treating intracranial aneurysms. Methods A total of 217 patients with subarachnoid hemorrhage were selected to undergo conventional digital subtraction angiography （DSA） and three-dimensional DSA （3D-DSA）. The effects of conventional DSA and 3D-DSA were compared in revealing the location, size, shape, and neck of the aneurysms. Interventional endovascular embolization or surgical clipping were performed in patients who were diagnosed as intracranial aneurysms. The therapeutic results were evaluated in some patients with 3D-DSA after operation. Results Conventional DSA revealed 139 patients （64. 1% ） with 153 aneurysms; and 3D-DSA revealed 156 patients （71. 9% ） with 177 aneurysms （the detection rate increased 7. 8%, P 〈0. 01 ）. Three 〈2 mm microaneurysms were missed and 5 false positive aneurysms patients were found by conventional DSA. 3D-DSA was obviously better than conventional DSA in revealing aneurysm neck, shape of aneurysms and spacial relation with parental artery. Ninety-seven patients underwent coiling, the aneurysms in 52 were clipped, and 7 were treated conservatively. Eighty-four patients with coiling and 45 patients with dipping were successfully obliterated. Conclusion The 3D-DSA technique may significantly increase the accuracy in detecting aneurysms and three-dilnensionally display the size, shape, neck of the aneurysms, and spacial relation with the parental artery. It may provide precise informations for management of the aneurysms appropriately.