多层螺旋CT三维血管造影对颅内动脉瘤的诊断价值

Value of 3-dimensional multi-slice computed tomography angiography in the diagnosis of intracranial aneurysm

目的 80%的蛛网膜下腔出血都是由颅内动脉瘤破裂引起的。颅内动脉瘤一旦发生破裂出血,死亡率可达50%。文中旨在探讨多层螺旋CT三维血管造影(three-dimension multi-slice computed tomography angiography,3D-MSCTA)对颅内动脉瘤诊断的价值。方法回顾分析经数字减影血管造影术(digital subtraction angiography,DSA)及临床手术证实的42例自发性蛛网膜下腔出血(subarachnoid hemorrhage,SAH)患者的3D-MSCTA影像学表现。42例患者均行CT平扫及增强扫描,增强扫描后运用容积再现(volume redering,VR)、多层平面重建(multiplanar reformation,MPR)、最大信号密度投影(maxi-mum intensity projection,MIP)技术重建三维脑血管,并参照原始图像进行观察。结果 42例患者经3D-MSCTA检查后,40名患者诊断为颅内动脉瘤,共发现动脉瘤44个,2例未见明确颅内动脉瘤;经DSA检查,41名患者诊断为颅内动脉瘤,共发现动脉瘤46个,1例未见明确颅内动脉瘤;3D-MSCTA检查对颅内动脉瘤检出敏感性为95.7%。结论 3D-MSCTA作为无创、操作简便的颅内动脉瘤的检查方法,具有很高的敏感性(95.7%),可作为一种安全、快捷的常规筛查方法,亦可为拟定治疗方案提供详细的资料。对于3D-MSCTA检查未发现颅内动脉瘤的自发性蛛网膜下腔出血患者应进一步行DSA检查。

Objective Eighty percent of subarachnoid hemorrhage is induced by ruptured intracranial aneurysm,and its mortality is as high as 50%.This article aims to evaluate 3-dimensional multi-slice computed tomography angiography（3D-MSCTA） in the diagnosis of intracranial aneurysm.Methods We retrospectively analyzed the 3D-MSCTA images of 42 cases of spontaneous subarachnoid hemorrhage（SAH） confirmed by digital subtraction angiography（DSA） and surgery.All the patients underwent CT scanning and enhanced CT scanning,followed by three-dimensional reconstruction of brain blood vessels using VR,MPR and MIP techniques.And observations were made by reference to the original images.Results Of the 42 patients,40 were diagnosed with 44 intracranial aneurysms by 3D-MSCTA,and 41 with 46 aneurysms by DSA.The detection rate of intracranial aneurysm by 3D-MSCTA was 95.7%.Conclusion 3D-MSCTA,non-invasive and highly sensitive,can be used as a safe and fast conventional screening method for the diagnosis of intracranial aneurysm,as well as for providing detailed information for its treatment protocol.Further examination by DSA can be performed if 3D-MSCTA fails to reveal intracranial aneurysm in patients with spontaneous subarachnoid hemorrhage.