CT鉴别诊断颅内动脉瘤栓塞术后对比剂残留与蛛网膜下腔出血

CT differential diagnosis of contrast medium after intracranial aneurysm embolization with subarachnoid hemorrhage

目的观察CT鉴别颅内动脉瘤电解可脱式铂金弹簧圈(GDC)栓塞术后对比剂残留与蛛网膜下腔出血(SAH)的诊断价值。方法回顾性分析55例SAH患者及45例颅内未破裂动脉瘤GDC栓塞术后患者的CT特征。结果 55例SAH患者中,出血以鞍上池(44/55,80.00%)、外侧裂(25/55,45.45%)分布为主;45例颅内未破裂动脉瘤GDC栓塞术后患者颅内高密度分布以静脉窦(39/45,86.67%)、后纵裂(20/45,44.44%)、小脑幕(18/45,40.00%)分布为主;GDC栓塞术后脑内高密度CT值升高明显,平均值大于75HU,与SAH比较边界相对清晰,对脑裂、脑池及静脉窦正常形态影响小。结论 CT显示的病灶分布部位、密度、形态有助于鉴别GDC栓塞术后对比剂残留造成的颅内高密度影与动脉瘤破裂出血导致的SAH。

Objective To assess CT features of contrast medium after guglielmi detachable coil （GDC） embolization for aneurysm and subarachnoid hemorrhage （SAH）. Methods CT manifestations of 55 patients with SAH and 45 patients with intracranial aneurysm after GDC embolization were retrospectively analyzed. Results In 55 SAH patients, the bleed- ing mainly located in suprasellar cistern （44/55, 80.00%） and sylvian fissure cistern （25/55, 45.45%）. In 45 patients with intracranial aneurysm after GDC embolization, the intracranial high density mainly located in sinus （39/45, 86.67 %）, posterior longitudinal fissure （20/45, 44.44%） and tentorium cerebelli （18/45, 40.00%）. The intensity increased signifi- cantly after GDC （mean value 〉75 HU）, having relatively clear boundary, and little influence on the split brain, cerebral venous sinus and normal form pool. Conclusion The intracranial high density caused by residual contrast agents after GDC embolization for intracranial aneurysm, and SAH can be distinguished by CT through analyzing the features such as loca- tion, density and shape.