三维CT脑血管造影在自发性蛛网膜下腔出血诊疗中的应用

Clinical application of 3D MSCTA in 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。方法回顾搜集我院2008年5月-2010年5月经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(24小时内)行多排螺旋CT血管造影检查,并和诊断SAH的"金标准"DSA全脑动脉造影检查比较,突显MSCTA在SAH患者超急性期病因诊断的优势。结果 48例患者中发现动脉瘤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。ICCF 1例,显示扩张的海绵窦大小、形态、范围及迂曲的引流静脉,可显示CCF的瘘口;静脉性血管畸形2例;不明原因4例。对脑血管病的检出敏感性为95%,特异性为100%。结论 3D 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,它提供的信息对尽快确定治疗方案,争取宝贵的抢救时机有极大帮助,对脑血管病变的检出具有较高的敏感性和特异性。

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 Performance of MSCTA and DSA in 48 cases of superacute of SAH（within 24 hours） definite diagnosed by plain scan with CT and lumbar puncture in our hospital from May,2008 to May,2010 were reviewed retrospectively and compared,reveal the advantage of MSCTA in etiological diagnosis of super acute SAH.Results With MSCTA,48 patients were found aneurysm 34,AVM 7,CCF 1,venous malformation 2,unknown origin 4.Of the aneurysm,the aneurysmal body and neck,parent artery and relationship to adjacent vessels and skulls were displayed clearly and exactly.Of the Arteriovenous Malformation（AVM）,the position,shapes,sources of the feeding artery,branch of the draining vein and stereochemical structure of the nidus were showed clearly.Of Carotid Cavernous Fistula（CCF）,the size,shape and ambit of the dilated cavernous sinus,circuitous draining veins and orificium fistulae of CCF were showed.Conclusions 3D MSCTA,as a simple,fast,non invasive,safe and reliable technique of Cerebral Angiography,can take the place of DSA to some extent,and also can be regarded as the first choice of superacute SAH etiological diagnosing.MSCTA can provide more information for diagnosis and treatment.