16层螺旋CT三维血管造影在颅内动脉瘤中的诊断及临床应用价值

The Diagnostic and Clinical Application Value of Three Dimensional CT Angiography in Intracranial Aneurysm

目的探讨三维CT血管造影(three dimensional computed tomographic angiography,3D-CTA)在颅内动脉瘤的临床应用及其价值.方法对自发性蛛网膜下腔出血及怀疑颅内血管瘤的病例共53例患者,行3D-CTA检查(时间在发病后4h到3d).并行数字减影血管造影(digital subtraction angiography,DSA)检查.结果经3D-CTA、DSA和手术共同证实发现44例共49个动脉瘤.在44例动脉瘤患者中,3D-CTA发现42例47个动脉瘤.DSA发现43例48个动脉瘤.动脉瘤的瘤体最大径及瘤颈最大径3D-CTA测量值与DSA测量值比较差异无统计学意义(t=0.59和t=0.49,均为P>0.05).表明3D-CTA所显示颅内动脉瘤位置、大小、数量等结果与DSA检查基本相符.53例病情轻重不一患者在行3D-CTA检查过程中,病情无加重或无其他意外发生.结论3D-CTA对颅内动脉瘤诊断准确率高,可精确显示动脉瘤的三维空间形态率,与DSA检查互补可得到颅内动脉瘤更完整的信息其有快捷、经济、安全和微创等优点.

Objective To evaluate the value of clinical application of three-dimensional computed tomo- graphic angiography （3D - CTA） in intracranial aneurysm. Methods Fifty-three consecutive patients with acute subarachnoid hemorrhage and clinical-highly-suspected intraeranial aneurysms underwent 3D-CTA scanner before admission （at 4 h - 3 d after onset）. Then conventional digital subtraction angiography （DSA） was performed after 3D-CTA. Results A total of 49 aneurysms （diameter 1.7- 25 mm） were detected by 3D-CTA, DSA and operation in 44 patients. Forty-seven aneurysms were detected by 3D-CTA in 42 of 44 patients. DSA demonstrated 48 aneurysms in 43 of 44 patients. There was no significant difference between 3D-CTA and DSA in size of intracranial ameurysms and in width of neck of intraeranial ameurysms （t=0.59, t=-0.49 P 〉 0.05 ）. The position, size and quantity of intracranial aneurysms displayed by 3D-CTA were accordant with the results of DSA. All patients did not show any new neurological deficits or deteriorating neurological deficits during 3D-CTA examination. Conclusions 3D - CTA is a quick, safe, economic and relatively noninvasive method for the diagnosis of intracranial aneurysms, and it is possible to better evaluate detail of intracranial aneurysmal, display of blood vessel and relationship with surrounding structures. More information of intracranial aneurysms can be learned from combination of 3D - CTA and DSA.