320排CTA诊断脑动静脉畸形破裂出血

320-detector row CT angiography in diagnosis of cerebral arteriovenous malformation with hemorrhage

目的探讨320排CTA在脑动静脉畸形(AVM)破裂出血诊断中的价值。方法收集接受颅脑CTA检查并经病理和(或)DSA证实的脑AVM破裂出血患者45例,均接受增强动态容积多期CT扫描;利用sub/add软件得到动脉期和静脉期减影数据,对其进行VR、MIP,获得仿真脑动脉、静脉减影图像;回顾性分析原始及重建图像。21例同时接受CTA与DSA检查,对CTA与DSA显示的供血动脉与引流静脉的数目进行统计学分析。结果 CTA检出44例脑AVM,其中幕上39例(颞叶最多,8例,顶叶次之,7例),幕下5例,均位于小脑;漏诊1例。AVM破裂出血表现为脑实质血肿41例,蛛网膜下腔出血4例;单条动脉供血37例,2条动脉供血7例;引流至浅表静脉窦29例,引流至深静脉15例。CTA与DSA对AVM供血动脉、引流静脉的显示差异无统计学意义(P>0.05)。结论 320排CTA可作为诊断脑AVM破裂出血安全、准确的首选影像学检查方式。

Objective To explore the value of 320-row detector CTA in the diagnosis of cerebral arteriovenous malforma- tion （AVM） with hemorrhage. Methods All 45 patients with cerebral AVM diagnosed by histopath01ogy and （or） DSA were enrolled. 320-row detector CTA were performed on all patients using dynamic volume scan mode. Arterial subtraction data and venous subtraction data were acquired with sub/add software. Virtual images of cerebral arteries and veins were obtained with VR and MIP. The original and reconstruction images were retrospectively analyzed. Twenty-one patients un- derwent both CTA and DSA. The amount of feeding arteries and draining veins on CTA and DSA were analyzed statistical- ly. Results Cerebral AVM was revealed in 44 patients by CTA, including 39 cases located supratentorially （the most loca- ted in temporal lobe, then in parietal lobe） and 5 located infra-tentorially in the cerebellum. One case of AVM was missed by CTA. The cerebral hematoma was demonstrated in 41 cases and subaraehnoid hemorrhage in 4 cases. Single feeding artery was found in 37 cases, while dual feeding arteries were detected in 7 cases. There were superficial venous drainage in 29 cases and deep venous drainage in 15 cases. No significant difference between CTA and DSA in displaying of intracranial AVM＇s feeding arteries and draining veins was found （P〈0.05）. Conclusion 320-row detector CTA has potential to serve as a safe, accurate and preferred examination for cerebral AVM with hemorrhage.