三维CT血管造影术在急性蛛网膜下腔出血颅内动脉瘤诊断中的应用

Application of 3D-CTA in diagnosing intracranial aneurysms patients with acute subarachnoid hemorrhage

目的探讨三维CT血管造影术(3D-CTA)在急性蛛网膜下腔出血(SAH)颅内动脉瘤诊断中的应用。方法采用3D-CTA和DSA对26例非外伤性SAH患者进行检查,3D-CTA通过最大密度投影(MIP)、表面遮盖法重建(SSD)和容积重建术(VRT)方法获得图像,根据3D-CTA和DSA所获得的关于动脉瘤的位置、大小等进行术前评估。结果在26例中24例3D-CTA检测出27个动脉瘤,瘤体直径3～21 mm,1例后交通动脉瘤3D-CTA不能证实,1例未检出动脉瘤;14例行DSA检查,其中1例未检出动脉瘤而通过3D-CTA发现,1例右椎动脉梭形动脉瘤因DSA行右椎动脉造影失败而通过3D-CTA发现。12例仅凭3D-CTA手术,3D-CTA在检查动脉瘤的位置、大小、瘤体方向及对载瘤动脉和分支动脉的形态描述均优于DSA,它在诊断颅内动脉瘤的敏感性和特异性分别为96%和100%。结论3D-CTA是一种准确、价廉、非侵袭性的诊断颅内动脉瘤SAH的方法,在动脉瘤的急诊手术时较DSA更具优越性。

Objective To investigate the application of three-dimensional multislice helical CT angiography （3D-CTA） in the diagnosis of cerebral aneurysms in the patients with acute subarachnoid hemorrhage （SAH）. Methods 3D-CTA and digital subtraction angiography （DSA） examinations were performed in 26 SAH cases. 3D-CTA data were obtained by maximum intensity projection （MIP）, shaded surface display （SSD） and volume rendering technique （VRT）. 3D-CTA and DSA findings were evaluated and compared in aspects of number, location and size of aneurysms. Results In the 24 patients, 3D-CTA detected 27 aneurysms with diameters ranging from 3 to 21 ram, while 1 case was found flee of aneurysm and 1 posterior communicating artery aneurysm was not demonstrated by 3D-CTA. DSA was performed in 14 cases, among which 1 case was found to have an aneurysm by 3D-CTA not by DSA, and 1 case of right vertebral artery aneurysm was also showed by 3D-CTA not by DSA because the right vertebral artery angiography was failure. The other 12 cases underwent only 3D-CTA. 3D-CTA was superior to DSA in displaying the site, size and orientation of the aneurysms and showing the parent artery and its branches. 3D-CTA sensitivity was 96% and specificity was 100% in the diagnosis of intracranial aneurysms. Conclusion 3D-CTA is a highly accurate, cheap and non-invasive imaging method in the diagnosis of intracranial aneurysms in cases with SAH and can be used as a safe alternative method to DSA, especially during the emergency surgery.