颅内动脉瘤的CTA术前诊断

Preoperative Diagnosis of Intracranial Aneurysm with CT Angiography

目的:评价CT血管造影(CTA)在颅内动脉瘤的术前诊断价值及对最大密度投影(MIP)、表面遮盖显示(SSD)和容积显示技术(VRT)作用的比较。材料和方法:对36例CT平扫怀疑患有颅内动脉瘤的患者进行CTA检查,初选27例动脉瘤患者分别进行MIP、SSD及VRT成像,观察动脉瘤的部位、形态、生长方向及载瘤动脉;进行瘤体大小及瘤颈宽度的测量,部分病例与术中结果比较。结果:27例动脉瘤患者中,动脉瘤大小:5-60mm。瘤颈呈蒂状(颈宽<10mm)18例、宽颈(颈宽≥10mm)9例。载瘤动脉分别为:大脑中动脉(12例)、大脑前交通动脉(7例)、颈内动脉虹吸部(6例)、基底动脉(2例)。蒂状窄颈动脉瘤均行手术治疗,术后恢复良好;1例瘤颈宽为10mm手术后患者所在中动脉闭塞,脑组织缺血性梗死,9例均放弃手术。结论:CTA可作为动脉瘤的有效术前筛选诊断,可作为神经外科医师手术前的重要指导方法之一。

Purpose: To evaluate if computed tomographic angiography can be regarded as preoperative imaging diagnostic role in patients with intracranial aneurysm.Materials and Methods: 36 cases with recent subarachnoid hemorrhage, hematoma or acute trigeminal neuralgia shown by unenhanced CT scanning, suspected intracranial aneurysm, were studied with CT angiography. Using Maximum Intensity Projection (MIP), Shaded Surface Display (SSD) and Volume Rendering Technique (VRT), source images to detect aneurysmal location, shape,orientation, parent artery, to measure aneurysm diameters, neck and to predict preoperative possibility. Results: 27 aneurysms were found MCA( 12 cases), anterior communicating artery (7), carotid siphon (6), basilar artery (2), The aneurysm diameters from 5 mm to 60 mm, the width of the aneurysm neck less than 10 mm (18), more than 10 mm (9), 7 cases locating Willis, MCA ( < 10 mm neck width) were operated, and succeeded, one case of two( = 10 mm neck width) operated but had acute right hemisphere infarct after 24 hours operation, another case were given up, other cases were given up because of lower location, base - skull effection, and wider neck( > 10 mm). Conclusion: A combination of MIP, SSD and VRT on CTA can be regarded as a simple imaging diagnostic tool for intracranial aneurysm with preoperative plan.