脑血管造影三维重建成像在脑动脉瘤诊断和治疗中的初步应用

3-D angiography in diagnosis and treatment of intracranial aneurysm

目的 总结脑血管造影三维重建成像在脑动脉瘤诊断和治疗中的初步应用经验 ,以提高诊断水平和治疗效果。 方法 对 6 5例确诊或疑诊为脑动脉瘤的病例分别行常规脑血管造影成像 (二维影像 )和脑血管造影三维重建成像 (三维影像 )检查 ,并对其结果进行对比分析。 结果 6 5例患者经上述检查 ,共检出 6 0例 6 6个动脉瘤 ,5例造影阴性。 6 0例 6 6个动脉瘤中 ,囊内栓塞 43例 46个 ;行载瘤动脉闭塞 3例 3个 ;外科手术 10例 10个 ;颅内外动脉搭桥术后闭塞载瘤动脉 1例 1个 ;未治疗 3例 6个。有 2个动脉瘤二维影像上未显示 ,而三维影像上显示 ;3个动脉瘤通过二维影像认为不适合栓塞或栓塞十分困难或危险 ,通过三维影像的帮助得以栓塞 ;3个动脉瘤二维影像上显示可行栓塞 ,而三维影像发现不能栓塞。囊内栓塞的 46个动脉瘤中 ,38个 (82 6 % )二维影像上达 10 0 %栓塞 ,但其中 8个三维影像上有残留。

Objective To summarize the results of initial application of three dimensional angiography (3D Angio) in diagnosis and treatment of intracranial aneurysms. Methods From August 1999 to January 2001, standard digital subtraction angiography (two dimensional angiography, 2D Angio) and 3D Angio(obtained by reconstruction of rotational angiography) were performed in 65 patients with confirmed or suspected aneurysms. Results Sixty six aneurysms were found in 60 patients and nothing was found in 5. Of 66 the aneurysms (60 cases), 46 (43 cases) were treated by intrasaccule embolizotion with coils, 3 (3 cases) by occluding the parent artery with detachable balloon, 10 (10 cases) by surgery, and 1 (1 case) by combination of extracranial intracranial bypass and balloon occlusion of parent artery. Six (3 cases) were not treated. Two aneurysms that could not be detected by 2D Angio were diagnosed by 3D Angio. Three aneurysms that were difficult or dangerous to embolize by 2D Angio were embolized successfully with the help of 3D Angio. Three aneurysms seemed to be embolized on 2D Angio were proved impossible to be embolized on 3D Angio. Of the 46 aneurysms embolized intrasaccularly, 38(82 6%) were completely embolized on 2D Angio. In the 38, 8 had residual aneurysm on 3D Angio. Conclusion More accurate diagnosis and secure treatment of intracranial aneuzysm can be reached by 3D Angio.