螺旋CT血管生长技术及脑血管造影在烟雾病诊断中的价值

Clinical application of MSCTA and DSA in diagnosis of moyamoya disease

目的探讨使用多排螺旋CT血管生成技术(MSCTA)及脑数字减影(DSA)血管造影在烟雾病(MMD)中的诊断价值。方法采用8排螺旋CT进行头部螺旋容积扫描,分析23例烟雾病的CT平扫及增强的影像表现,利用"血管生长(add vessel)"法对图像进行后处理,采用多平面体积重组及容积重建图像对脑血管进行三维重建并和DSA结果进行比较分析。结果 CT平扫13例患者显示不同部位的脑出血,5例患者表现为多发性的脑梗死,3例患者仅见局限性的脑萎缩,2例患者CT平扫未发现明显异常。MSCTA均清晰显示不同程度的颈内动脉颅内段和(或)大脑前动脉、大脑中动脉狭窄或闭塞,23例均显示纤细迂曲的"烟雾"状异常血管网。其中15例经股动脉插管行全脑数字血管减影(DSA)证实。结论采用血管生成、容积重建技术,MSCTA是明确诊断烟雾病的有效非创伤性首选检查方法,可替代DSA进行烟雾病的筛选、诊断和随访观察。

Objective To investigate the diagnostic value of multi-slice spiral CT angiography （MSCTA） and digital subtraction angiography （DSA） in moyamoya disease （MMD）. Methods 23 patients with MMD accepted thin slice volume scan of 8-slices spiral CT. The images of plain and enhanced scan were analyzed, the data were processed based on add vessel technology and accepted vascular three-dimensional reconstruction with muhiplanar volume reformation （MPVR）, volume rendering （VR） synchronously. The results were compared with DSA. Results In CT scan images of the 23cases, 13 were showed different sited cerebral hemorrhage, 5 multiple cerebral infarction, 3 localized cerebral atrophy and 2 negative. The stenosis or occlusion with different degrees of intracranial internal carotid artery, anterior cerebral artery and/or middle cerebral artery was showed clearly by MSCTA. The tenuous and circuitous moyamoya vessels of the all 23 patients were showed by CTA and 15 were confirmed by DSA. Conclusion With technology of add vessel and VR, MSCTA is a preferred, effective and noninvasive diagnostic method of MMD and it could replace DSA in screening, diagnosing and following up observation.