颅内动脉瘤术后夹闭不全和载瘤动脉闭塞的64层CTA评价

The Evaluation of Incomplete Clipping and Parent Artery Occlusion of Intracranial Aneurysms with 64 Slice CT Angiography After Clipping Operation

目的评价颅内动脉瘤术后夹闭不全和载瘤动脉闭塞的CT血管造影(CTA)表现,分析导致夹闭不全和载瘤动脉闭塞的可能原因。方法回顾性分析118例颅内动脉瘤夹闭术后患者的CTA资料,使用64层螺旋CT扫描和多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)图像后处理技术,并与数字造影血管造影(DSA)对照,评价术后载瘤动脉的CTA表现,尤其是瘤夹的位置、夹闭不成功时残存瘤体的形态。结果 112例载瘤动脉通畅,6例经DSA证实有动脉瘤夹闭不全(5例)和载瘤动脉闭塞(1例)。所有钛夹显示清楚,无伪影。动脉瘤夹闭不全在CTA上表现为瘤夹周围残存小结节状、锥状、泡状或囊袋状动脉瘤影,分别位于前交通动脉处(2例)、右侧大脑中动脉水平段远端分叉处(2例)、左侧大脑中动脉水平段远端分叉处(1例)。1例左侧颈内-后交通动脉瘤夹闭术后载瘤动脉闭塞,CTA表现为相应节段的动脉未见显影。结论 64层MSCTA能清晰显示颅内动脉瘤术后钛合金瘤夹的位置与形态、载瘤动脉的通畅情况以及夹闭不全时残存的动脉瘤。

Objective To evaluate the appearance of CT angiography（CTA） of clipped intracranial aneurysms with incomplete clipping and patient artery occlusion,and analyze the possible reasons for the failure of clipping. Methods By using the 64 slice CT equipment and the reconstruction techniques of multi-planar reformatting（ MPR）,maximum intensity projection（ MIP）,and volume rendering technique（VRT）,118 cases of CTA imaging after clipping of intracranial aneurysms were analyzed. Compared to DSA,the images of the patient arteries were evaluated,especially the location of the clips and the shape of the aneurysm remnants. Results Complete aneurysm closure without remnant was confirmed in 112 cases,and the patient arteries were unobstructed. Five aneurysm remnants and one patient artery occlusion were confirmed by DSA. All clips were displayed distinctly without artifacts. The aneurysm remnants displayed small nodular,conical,vesicular or capsular shape in CTA. The location of aneurysm remnants was in anterior communication artery（2 cases）,right middle cerebral artery（2 cases）,left middle cerebral artery（1 case）,respectively. The patient artery occlusion showed out absent sign in CTA,which was located at the junction of the left internal carotid artery and posterior communicating artery. Conclusion The 64 slice spiral CT angiography clearly exhibited the shape of postsurgical intracranial aneurysm remnants,the location of titanium alloy clip and the patency of patient arteries.