摘要
目的 探讨三维CT血管造影（three dimensional computed tomographic angiography，3D—CTA）在颅内动脉瘤破裂急性期的临床应用及其价值。方法2003年6月至2005年2月间，对自发性蛛网膜下腔出血、临床高度怀疑颅内动脉瘤破裂的128例患者，在CT平扫确定蛛网膜下腔出血后，使用GE Lightspeed pro16层螺旋CT扫描仪行3D-CTA检查（时间在发病后2h到4d）。其中6例在3D-CTA之前行数字减影脑血管造影（digital subtraction angiography，DSA）检查，111例在3D-CTA之后行DSA检查。3D-CTA后处理图像与DSA图像由2位放射科医生用双盲法进行分析。结果 经3D-CTA和DSA共同证实发现112例患者有130个动脉瘤，动脉瘤大小为1．1～28mm，其中单发动脉瘤97例，多发15例33个动脉瘤（12例2个动脉瘤，3例3个动脉瘤）。在112例动脉瘤患者中，3D-CTA发现111例125个动脉瘤，其中多发12例26个动脉瘤（10例各2个动脉瘤，2例各3个动脉瘤）。在DSA检查的117例中，动脉瘤患者107例（5例未行DSA，3D-CTA后直接手术），DSA发现其中104例122个动脉瘤，显示多发动脉瘤15例（12例2个动脉瘤，3例3个动脉瘤）。112例患者在颅内动脉瘤破裂急性期3D-CTA检查过程中，病情无加重或无其他意外发生。结论 3D—CTA对颅内动脉瘤具有极高的敏感性和特异性，具有快捷、经济和相对无创等优点，可以完全替代DSA作为颅内动脉瘤破裂急性期的诊断。
Objective To evaluate the value of clinical application of three-dimensional computed tomographic angiography （3D-CTA） in ruptured intracranial aneurysms at acute phase. Methods One hundred and twenty-eight consecutive patients with acute subarachnoid hemorrhage and clinical-highly-suspected ruptured intracranial aneurysms underwent 3D-CTA by GE Lightspeed pro scanner before admission （at 2h～4d after onset）. Then conventional digital subtraction angiography （DSA） were performed in 111 patients after 3D-CTA. Six patients were performed DSA before 3D- CTA. All of the source images were processed into volume rendering （VR） and some of them have maximal intensity projection （MIP） . Images of 3D-CTA and DSA were reviewed by two independent blinded radiologist. Results A total of 130 aneurysms （diameter 1.1 -28mm） were detected by 3D-CTA and DSA in 112 patients. Everyone of ninety seven patients had a single aneurysm; fifteen patients had multiple intracranial aneurysms （MIA） , including everyone of twelve patients had two aneurysms and three had three aneurysms. One hundred and twenty-five aneurysms were detected by 3D- CTA in 111 of 112 patients （everyone of ten patients had two aneurysms and two had three aneurysms）. DSA demonstrated 122 aneurysms in 104 of 107 patients （everyone of twelve patients had two aneurysms and three had three aneurysms）. All patients did not show any new neurological deficits or deteriorating neurological deficits during 3D-CTA examination. One hundred and nine aneurysms of 105 patients were treated by surgery clipping or embolization. Conclusion 3D-CTA was a quick, economic and relative noninvasive method for the diagnosis of intracranial aneurysms, and had very high sensitivity and specificity, which can be used to diagnose ruptured intracranial aneurysms at acute phase instead of DSA.
出处
《中华急诊医学杂志》
CAS
CSCD
2006年第11期996-1001,共6页
Chinese Journal of Emergency Medicine
基金
国家"十五"攻关资助项目(2001BA703B18)
浙江省卫生厅科技计划资助项目(2003B117)
关键词
颅内动脉瘤
三维CT血管造影
破裂出血
Intracranial aneurysm
Three dimensional computed tomographic angiography
Rupture andhemorrhage
