三维CT血管造影术在颅内动脉瘤破裂早期诊治中的价值(附348例报告)

The value of three-dimensional computed tomographic angiography in the early diagnosis and treatment of ruptured intracranial aneurysms(348 cases reported)

目的评价三维CT血管造影术(3D-CTA)在颅内动脉瘤破裂早期诊断和治疗中的临床应用价值。方法对419例自发性蛛网膜下腔出血病例全部行3D-CTA检查,其中阴性病例再行DSA检查,对确诊为颅内动脉瘤的病例行显微外科手术或介入治疗。结果345例经3D-CTA检查阳性中检出动脉瘤365个,75例阴性病例中DSA证实仅有3例漏诊。348例动脉瘤患者共检测出动脉瘤368个,术中见动脉瘤位置及瘤体、瘤颈和周围解剖结构的关系与术前3D-CTA显示一致。术后病人3D-CTA随访,与术前比较,动脉瘤均夹闭完全、确实。结论3D-CTA是一种方便、可靠、快捷的诊断方法,可以作为颅内动脉瘤破裂诊治的首选影像检查,并且在术中及术后复查随访研究方面也具有重要的临床应用价值。

Objective To assess the clinical application and value of three-dimensional computed tomographic angiography （3D-CTA） in the early diagnosis and treatment of ruptured intracranial aneurysms. Methods All the 419 cases with spontaneous subarachnoid hemorrhage （SAH） were examined by 3D-CTA, among which negative cases also underwent digital subtraction angiography （DSA） and those who were definitely diagnosed as intracranial aneurysms were treated with microsurgical techniques or intervention therapy. Results Among the 3D-CTA diagnosed 345 positive cases, 365 aneurysms were detected; 3 among the 3D-CTA diagnosed 75 negative cases missed diagnosis, as confirmed by DSA. A total of 368 aneurysms were detected in the 348 cases with aneurysms, and the intraoperative aneurismal sites and the relationships of the aneurismal body and neck with the surrounding anatomical structures were in accordance with that of preoperative 3D-CTA detection. The postoperative follow-up study of 3D-CTA indicated that aneurysms were occluded completely and assuredly by aneurismal clips, as compared with preoperative status. Conclusion The 3D-CTA is a convenient, dependable and efficient imaging examination of the first choice for the diagnosis and treatment of ruptured intracranial aneurysms; it has significant clinical value in microsurgery and postoperative follow-up study.