螺旋CT血管造影在脑动脉瘤诊断及治疗中的应用——兼与MR血管造影比较

Application of Spiral CT Angiography in the Diagnosis and Treatment of Cerebral Aneurysms:Compared with MR Angiography

目的 :探讨无创性的螺旋CT血管造影(SCTA)与MR血管造影(MRA)对脑动脉瘤的诊断价值以及对治疗的指导价值 ,并对两者作比较。材料和方法 :28例患者同时行SCTA、MRA、DSA ,以DSA作为金标准 ,对SCTA与MRA作比较。结果 :(1)23例行SCTA及时间飞跃法(TOF)MRA者 ,SCTA诊断脑动脉瘤的准确性高于TOFMRA ,但差异无显著统计学意义(p>0.05)。(2)SCTA较TOFMRA测量脑动脉瘤的最大径准确性高(p<0.01) ,TOFMRA测量值常偏小。(3)SCTA测量的栓塞治疗最佳投照角度与DSA符合率94.7 %。(4)动态增强(DCE)MRA的图像清晰度及价值与SCTA相似。结论 :SCTA对体积小、破裂出血的脑动脉瘤的检出率以及对动脉瘤测量的精确性高于TOFMRA ,SCTA可较准确地测量动脉瘤栓塞治疗的最佳投照角度 ,MRA是脑动脉瘤电解可脱弹簧圈(GDC)栓塞术后随访的较好方法 ,DCEMRA的实用价值与SCTA相似。

Purpose:To assess the values of spiral CT angiography(SCTA) and MR angiography(MRA) in the diagnosis and treatment of cerebral aneurysms.The differences between these two noninvasive imaging modalities were studied at the same time.Materials and Method:28 cases of cerebral aneurysms underwent SCTA?MRA and DSA simultaneously.SCTA and MRA were compared by using DSA as gold standard.Results:(1)The detection rate of SCTA was higher than time-of-flight(TOF) MRA in 23 cases of cerebral aneurysm who underwent both these two examinations.But there is no signifieant statistic difference between them(p>0.05).(2)The accuracy of SCTA in measuring the diameter of cerebral aneurysm was higher than TOF MRA(p<0.01).TOF MRA often got smaller measurement than DSA.(3)The optimal projection angles used in the endovascular embolization chosen by SCTA were identical with DSA in 94.7% cases.(4)The image quality and value of dynamic contrast-enhanced(DCE) MRA were similar to SCTA.Conclusion:The accuracy of SCTA in diagnosing the small?ruptured cerebral aneurysms and measuring the diameter of the aneurysms was higher than that of TOF MRA.SCTA can measure the optimal projection angles for endovascular embolization accurately.MRA is a good method to follow-up the aneurysms treated with Guglielmi detachable coils(GDC).The value of DCE MRA is similar to SCTA.