螺旋CT诊断颅内动脉瘤23例分析

Spiral CT in the diagnosis of intracranial aneurysm: a report of 23 cases

目的：进一步了解螺旋CT诊断颅内动脉瘤的优点。方法：回顾性总结分析23例颅内动脉瘤病例,包括临床表现、影像学检查。所有患者均采用西门子16排螺旋CT机扫描,头颅CT平扫及CT血管造影（CT angiography,CTA）检查,扫描范围：颅底至颅顶,主要包括脑底动脉环。结果：9例患者有头痛、头晕症状,5例有突然头痛伴不省人事症状,13例有偏瘫,2例有发作性抽搐,10例有蛛网膜下腔出血。CT检查所见：平扫一般表现为类圆形稍高密度占位,无钙化或边缘有钙化。7例表现为片状低密度灶即脑梗死CT所见,6例表现为脑实质内出血,10例表现为广泛性蛛网膜下腔出血。CTA检查可清楚显示动脉瘤形态及所在部位。5例动脉瘤位于基底动脉,4例位于颈内动脉虹吸段,7例位于右侧大脑中动脉,5例位于左侧大脑中动脉,2例位于脑底动脉环前交通支。肿瘤呈圆形,类圆形8例,卵圆形12例,呈血管局限性增粗2例,呈葫芦形1例。直径1~3 cm,平均为2 cm,边界清楚、光滑。结论：螺旋CT诊断颅内动脉瘤准确率高,可以判断动脉瘤的范围及分型,图像直观,直接显示动脉瘤的部位,图像清晰。

Objective To evaluate the advantages of spiral CT in the diagnosis of intracranial aneurysm.Method Twenty-three cases with intracranial aneurysm were retrospectively analyzed,including clinical manifestations and imaging examinations.All the patients were scanned with Siemens 16-slice spiral CT machine,including cranial CT scan and CT angiography（CTA）,the scan range of skull base to cranial vault,mianly cerebral artery rings.Results Nine patients with headache and dizziness,5 with sudden headache plus unconscious symptoms,13 with hemiplegia,2 with episodic seizures,10 with subarachnoid hemorrhage.CT findings： the scan showed slightly higher density of occupancy with the shape of round or oval,without calcification or peripheral calcification.Seven patients showed lamellar low density lesions,6 showed parenchymal hemorrhage,10 showed extensive subarachnoid hemorrhage.CTA examination could clearly show the shape and location of the aneurysm,5 patients in the basilar artery aneurysm,4 in the siphon section of carotid artety,7 in the right side of middle cerebral artery,5 in the left side of middle cerebral artery,2 in anterior communicating branch of circle of willis.The shape of tumor was round or oval in 8 cases,orbicular-ovate in 12 cases,limited blood vessel dilation in 2 cases,gourd-shaped in 1 case.The diameter of tumor was 1~3 cm,the average of 2 cm,with clear and smooth boundary.Conclusion The diagnosis of intracranial aneurysm with spiral CT has high accuracy,can determine the extent and type of intracranial aneurysm,with direct-viewing of images,clearly showing the location of intracranial aneurysm and the images are clear.