MSCTA诊断前交通动脉瘤破裂的探讨

The value of multi-slice CT angiography in diagnosing ruptured anterior communicating artery aneurysm-compared with neuro-surgical operation findings

目的探讨多层螺旋CT血管造影(MSCTA)在前交通动脉瘤破裂急性期的临床应用价值。方法选取31例以蛛网膜下腔出血为首发症状,经全麻下开颅动脉瘤颈夹闭术证实的急性前交通动脉瘤破裂患者,所有患者术前均行MSCTA检查(其中10例进行了DSA检查),对其CTA资料进行回顾性分析,采用(VR),最大密度投影法(MIP)和仿真内窥镜(VE)等方法进行图像重组,多角度显示脑动脉树,观察前交通动脉瘤的形状、指向、大小、瘤颈宽度,动脉瘤与载瘤动脉、周边血管及骨质的关系,并在CT工作站上模拟手术入路。将上述指标同手术中所见进行对比,观察其一致性。结果手术证实32个动脉瘤,CTA检出31个,敏感性为96.9%,特异性为98%。CTA测量瘤体最大径及瘤颈宽度与手术中测量值比较均无统计学差异(t瘤体=1.51,P=0.14;t瘤颈=1.32,P=0.20,取α=0.05)。术前CTA清晰显示瘤颈、瘤体与载瘤动脉及颅骨的空间关系,与术中所见高度一致。结论MSCTA可作为破裂的前交通动脉瘤首选的筛检方法,并独立指导手术治疗,具有很大的临床应用价值。

Objective To assess the values of MSCTA in acute phase of ruptured anterior communicating artery aneurysm. Methods CTA images of 31 patients presented with acute subarachnoid hemorrhage （SAH） were reviewed. All the patients underwent neurosurgical procedure of aneurysm clip, by which ruptured anterior communicating artery aneurysms were confirmed. VR, MIP, VE were used to reconstruct the cerebral arteriograms. The cerebral arteriograms were observed from multi-directions to show the shape, size and neck of the anterior communicating artery aneurysm, as well as the relationship with the cartier artery, the surrounding vessels and the bone structure. A simulated surgical approach was also done with the computer workstation. All the information and data were compared with those recorded in neurosurgical procedures. Results 32 aneurysms were surgically confirmed, of which 31 were showed by CTA.The sensitive and specificity rate of CTA were 96.9% and 98% respectively. The diameters of aneurysm body and the neck measured by CTA and operation showed no significant difference （tbody=l.51, P= 0.14;tneck=l.32, P= 0.20, a=0.05）. CTA showed the spatial relationship of the aneurysm with its carrier arteries and the neighboring bony structures clearly. These signs were highly consistent with the relative surgical findings. Conclusion CTA can be used as the first choice to confirm the ruptured anterior communicating artery aneurysms, also, it can provide guiding information for making neurosurgical schedules. MSCTA has a great application values in acute case of ruptured anterior communicating artery aneurysms.