三维数字血管造影在颅内动脉瘤诊治中的应用

Three-dimensional rotational angiography in diagnosis and treatment of intracranial aneurysm

目的探讨三维数字血管造影（3D-RA）对颅内动脉瘤诊治的应用价值及其与常规DSA检查相比的优势。方法回顾资料完整的38例40枚颅内动脉瘤患者。分析全脑血管常规DSA造影及病变血管或病变疑似血管3D-RA检查和三维重建图像。分别观察记录常规DSA及3D-RA对颅内动脉瘤提供的诊断信息。24例采用手术开颅银夹夹闭动脉瘤治疗，14例采用血管内栓塞治疗。结果38例40枚颅内动脉瘤，其中前交通动脉瘤16枚，后交通动脉瘤13枚，大脑中动脉分叉部动脉瘤5枚，颈内动脉瘤3枚，椎基底动脉瘤2枚，小脑后下动脉瘤1枚；其中小型动脉瘤（动脉瘤体直径小于5mm）12枚，中型动脉瘤（动脉瘤体直径6～10mm）20枚，大型动脉瘤（动脉瘤体直径16-25mm）6枚，巨型动脉瘤（动脉瘤体直径大于25mm）2枚;动脉瘤呈囊袋状23枚，呈哑铃形12枚，不规则形4枚，梭形1枚;颅内动脉瘤单发36例，多发2例。常规DSA诊断动脉瘤37枚，占92．5％（37／40），3D-RA诊断动脉瘤40枚，占100％（40／40）。经与手术或血管内栓塞治疗结果比较，本组DSA诊断颅内动脉瘤敏感性92．5％，特异性100％，准确率96％。3D-RA诊断颅内动脉瘤敏感性及特异性均为100％，准确率100％。结论3D-RA能较常规DSA更好的显示颅内动脉瘤的形态、大小、瘤颈部及载瘤动脉与动脉瘤的关系、动脉瘤囊腔有无重要分支发出等等。

Objective To explore the value of three-dimensional rotational angiography （3D-RA） compared with routine DSA examination in diagnosis and treatment of intracranial aneurysms. Methods The imaging materials of routine DSA and 3D-RA of 38 patients with 40 aneurysms were reviewed. The abnormal vessels or suspected ones were performed angiography with oblique view as well as 3D-RA and then reconstructed. The information for aneurysms by routine DSA and 3D-RA were observed. 24 patients got surgery operation and 14 patients were cured by endovascular embolization. Results Forty intraeranial aneurysms were diagnosed in 38 patients： 16 on anterior communication arteries, 13 on posterior communication arteries, 5 on bifurcation of middle cerebral arteries, 3 on internal carotid arteries, 2 on vertebrobasilar arteries, and 1 on inferior posterior cerebellar artery; 12 in small size （〈5 mm）, 20 in middle size （6-10 mm）, 6 in big size （16- 25 mm）, and 2 were giant （〈25 mm）; 23 as cyst type, 12 as dumbbell, 4 irregular shape, and 1 as fusiform. 36 cases were with single lesion, 2 with multiple. According with the results of surgery or endovascular embolization, the sensitivity, specificity and accuracy with routine-DSA were 92.5%, 100% and 96% respectively; the values with 3D-RA were all 100%. Conclusion 3D-RA can take better play in diagnosis and treatment of intracranial aneurysm than that of routine DSA in shape, size, the relationship between aneurysm and feeding arteries and embranchment from aneurysm.