64排螺旋CT血管造影诊断颅内镜像动脉瘤

sixty-four rows helical CT angiography in diagnosis of intracranial mirrorimage aneurysm

目的探讨64排螺旋CT血管造影(CTA)在颅内镜像动脉瘤(IMIA)诊断中的临床应用价值。方法分析经显微外科手术和介入栓塞证实的20例IMIA患者的临床资料。20例IMIA术前均经64排螺旋CTA检查确诊,CTA扫描层厚0.625mm,后处理技术包括多层面重建(MPR)、表面遮盖三维重建(3-SSD)、容积显示重建(VR)、最大密度投影重建(MIP),并对照手术及介入栓塞治疗评估其诊断价值。结果 20例IM-IA患者64排螺旋CTA共发现42个动脉瘤,其中2个动脉瘤19例,4个动脉瘤1例。两侧动脉瘤的位置、大小、形态完全对称(Ⅰ型)7例,不完全对称(Ⅱ型)13例。64排螺旋CTA能清晰显示IMIA的位置、瘤体大小、瘤颈宽度、瘤顶指向、载瘤动脉及动脉瘤与临近血管和骨性组织间的空间关系。结论 64排螺旋CTA诊断颅内镜像动脉瘤具有较高准确性,可作为IMIA诊断的首选无创伤检查方法。将IMIA分为Ⅰ型和Ⅱ型有助于判断出血的责任动脉瘤。

Objective To evaluate the clinical value of sixty-four rows helical computed tomography angiog- raphy （CTA） in diagnosis of intraeranial mirrorimage aneurysms （IMIA）. Methods The clinical data of 20 cases with 42 IMIAs which underwent microsurgical operation or interventionl treatment were analysed retrospectively. Twenty cases of IMIAs were diagnosed by sixty-four rows helical CTA. The CT scan slice thickness was 0. 625mm. The data of all patients were reconstructed with multi plane reconstruction（ MPR）, 3dimensionl shade surface display （3SSD） , volume rendering（VR） , maximum intensity projection （MIP）. The value of CTA were evaluated with the results of surgery or interventionl treatment. Results A total of 42 IMIAs were detected by sixty-four rows helical CTA in 20 patients, two aneurysms in 19 patients,four aneurysms in 1 patient. The size and the shape of both sides of the IMIAs perfectly symmetry （ model I ） in 7 cases and inperfectly symmetry （ model 11 ） in 13 cases, sixty-four rows helical CTA could demonstrate the position, size, shape, neck, axis point of the aneurysms and the three dimensional relationship between aneurysms and parent vessels and other branches and bone structure more clearly. Conclusion sixty-four rows helical CTA is a high accuracy method for detecting IMIAs and it can be used as the first choice of screening IMIAs. It can help to determine the responsibility aneurysm of ruptured aneurysms if the IMIA had been divided into model Ⅰ and model Ⅱ.