容积重建成像3D—CTA与3D—DSA在诊断急性破裂性颅内微小动脉瘤的研究

Comparison between 3D-CrA with volume reconstruction and 3D-DSA in diagnosis of acute rupture of minute cerebral aneurysms

目的对比研究容积重建成像三维凹血管造影与三维DSA（3D—DSA）在颅内微小动脉瘤诊疗中的临床应用价值。方法对广东省人民医院2007年5月至2008年11月收治的174例蛛网膜下腔出血患者首先采用采用GE公司的hghtSpeedHus64排容积螺旋CT机获得原始图像，采用容积重建成像技术（VR）进行三维重建，并辅助运用多轴面重建（MPR），然后再行全脑血管造影术，并行3D—DSA成像。结果本组174例蛛网膜下腔出血患者诊断为颅内微小动脉瘤11例，均经开颅手术证实；其中CTA诊断11例，3D—DSA诊断10例。容积重建成像CTA清晰显示颅内微小动脉瘤、载瘤动脉、动脉瘤的形状和大小及其与邻近结构的解剖关系，与3D—DSA差异无统计学意义。结论容积重建成像CTA是一种可靠、无创的快速诊断颅内微小动脉瘤的方法，为急症手术提供了详实的影像学资料，可帮助制定治疗方案。

Objective To evaluate the diagnostic value of three dimensional computed tomographic angiography （3D-CTA） with volume reconstruction （VR） and 3D digital subtraction angiography （3D-DSA） in diagnosis of minimal cerebral aneurysms. Method A total of 174 patients in Guangdong General Hospital, May 2007 to November 2008, of subarachnoid hemorrhage were checked upon the original imaging obtained by GE＇ s Light Speed Plus 64 volume spiral CT scarmer at first, and then by the means of using Volume rendering （VR） three dimensional reconstruction and assisting the use of multiple planar reconstruction （MPR） to complete the 3D-DSA imaging at last. The volume rendering （VR） was assessed. Results Eleven very small cerebral aneurysms in 174 patients with subarachnoid hemorrhage were diagnosed by CTA and 10 of them by 3D-DSA. Finally, all of 11 patients were confirmed by intraeranial operations. The 3D-CTA （VR） clearly showed the shape and size of the intracranial aneurysms and their relationship to adjacent structures as well. There was no significant difference in the diagnosis of very small cerebral aneurysms between 3D-DSA and 3D-CTA （VR）. Conclusions The 3D-CTA （VR） is a reliable and rapid non-invasive diagnostic device for very small intracranial aneurysrns. For the emergency operation, 3D-CTA （VR） can provide more detailed imaging information to help the development of treatment strategy.