MSCTA在自发性蛛网膜下腔出血超急性期诊疗中的应用

Clinical application of MSCTA in superacute spontaneous subarachnoid hemorrhage

目的探讨多排螺旋CT三维血管成像(MSCTA)在自发性蛛网膜下腔出血(SAH)超急性期诊疗中的作用、评价MSCTA在SAH患者病因诊断学中的价值。方法回顾分析经CT平扫及腰穿明确诊断的自发性蛛网膜下腔出血48例患者,在超急性期(24h内)行多排螺旋CT血管造影检查,并与DSA全脑动脉造影检查比较。结果48例患者中MSCTA发现动脉瘤34例,显示瘤体、瘤颈、载瘤动脉和与周围血管及颅骨的关系清晰、确切;动静脉畸型(AVM)7例,显示畸形血管团的部位、大小、供血动脉来源,引流静脉的分支情况,空间立体结构清晰。颈内动脉海绵窦瘘(ICCF)1例,显示扩张的海绵窦大小、形态、范围及纡曲的引流静脉,可显示ICCF的瘘口;静脉性血管畸形(CVM)3例;不明原因3例。对脑血管病的检出敏感性为95%,特异性为100%。结论MSCTA是简单、快速、无创、安全、可靠的脑血管成像技术,在一定程度上可替代DSA检查,可作为SAH超急性期患者病因诊断的首选检查方法。

Objective To investigate the effect of multi-slice CT angiography （MSCTA） in diagnosing superacute spontaneous subarachnoid hemorrhage （SAH） and evaluate the value of MSCTA in etiological diagnosis for SAH. Methods A total of 48 patients with spontaneous subarachnoid hemorrhage diagnosed by plain scan with CT and lumbar puncture were analyzed retrospectively. All the patients accepted MSCTA scan in superacute period （within 24 hours）. Then evaluated MSCTA at the standard of cerebral angiography. Results With MSCTA, 34 aneurysms, 7 AVM, 1 ICCF and, 3 cerebral CVM were found in 48 patients. The aneurysmal body and neck, parent artery and relationship with adjacent vessels and skulls were displayed clearly and exactly by MSCTA. The position, shape, sources of the feeding artery, branch of the draining vein and stereochemical structure of the nidus of AVM were showed clearly. In the patient with ICCF, the size, shape and ambit of the dilated cavernous sinus, circuitous draining veins and orificium fistulae of ICCF were observed satisfiedly by MSCTA. The sensitivity and specificity for MSCTA of detection of SAH with were 95 % and 100%, respectively. Conclusion MSCTA, as a simple, fast, non-invasive, safe and reliable technique of cerebral angiography, can take place of DSA on some degree, and be regarded as the first choice on etiological diagnose of superacute SAH.