64层螺旋CT脊髓血管造影诊断脊髓血管畸形的临床应用研究

Clinical application of spinal angiography in diagnosing spinal cord vascular malformation with 64-detector row spiral CT

目的:探讨64层螺旋CT脊髓血管造影在诊断脊髓血管畸形中的价值。材料与方法:17例MRI及临床表现符合脊髓血管病的病人,做CT脊髓血管造影检查,其中14例于1周内做DSA检查。CT扫描方法:Toshiba Aquilion 64 Slice CT扫描机,0.5mm层厚,0.5/r,120kV,350mA,主动脉弓层面为监测平面,造影剂自动跟踪技术,CT阈值180HU。造影剂为碘海醇(370mgI/ml),注射流率6ml/s,总量80ml。从血管畸形的分型、病变范围、供血动脉、瘘口及引流静脉等方面对CT脊髓血管造影图像进行评价,并与DSA及手术结果对比。结果:17例脊髓CTA均明确显示脊髓血管的异常及病变的范围,其中1例MRI及脊髓CTA诊断为动静脉瘘,并经手术证实,但DSA却未显示出病变;除1例DSA为AVM合并AVF的病例脊髓CTA只看到了AVM未诊断出AVF外,其余病例均与DSA的分型结果一致;13例做脊髓CTA并DSA阳性结果的病例共有20根供血血管,脊髓CTA16根诊断正确,4根未显示,并出现了2根假阳性结果;6例脊髓CTA未看到瘘口;所有病例均清楚显示了引流静脉并与DSA一致。结论:CT脊髓血管造影对脊髓血管畸形的诊断有很大价值,可作为DSA检查前的筛选检查,并对DSA有指导作用,可缩短DSA检查时间。

Objective： To explore the value of CT spinal angiography in diagnosing spinal cord vascular malformation by 64-detector row spiral CT. Methods： Seventeen patients with initial MR and clinical findings suggestive of spinal vascular diseases underwent CT spinal angiography. Among these, 14 patients were performed DSA later within 1 week, and 7 patients underwent surgical treatment, 6 patients underwent vascular intervention embolotherapy. CT protocol： Toshiba Aquilion 64 Slice CT scanner, 0.5mm thickness, 0.5/r, 120kV, 350mA, choose aortic arch level as inspection position, and use ＂sure start＂ technique with CT threshold 180HU. Contrast medium was Iohexol （370mgl/ml）, injection velocity 6ml/s, total volume 80ml. CT spinal angiography were evaluated based on disease typing, disease range, feeding arteries, fistulas, draining veins of vascular malformation and compared with DSA and operation results. Results： All of the 17 patients showed clearly the abnormality of spinal cord vessels and the range of lesions by CT spinal angiography. Among them, one patient was diagnosed as arteriovenous fistulas（AVF） by MRI and CT spinal angiography, which was verified by surgical operation. However, DSA didn＇t visualize the lesion. One case was diagnosed as AVM complicated with AVF by DSA, but CT spinal angiography could only： show AVM, and didn＇t visualize AVF. The typing of all the other 16 patients agreed with DSA. Thirteen cases which obtained positive results of CT spinal angiography and DSA displayed 20 feeding vessels. Among them, 16 vessels were displayed correctly by CT spinal angiography, 4 vessels were not visualized, and 2 false-positive results were obtained. Fistulas were not shown in six cases by CT spinal angiography. Draining veins were displayed clearly in all cases, and agreed with DSA. Conclusion： There are great values for CT spinal angiography in diagnosing vascular malformation of spinal cord. It can be a screening exam before DSA, and has a guiding effect on DSA, reducing the amount of time required for DSA.