脑血管痉挛螺旋CT血管造影临床应用  

Clinical application of spiral-CT angiography to detecting cerebral vasospasm

作　　者：胡元明[1] 魏玮[1] 李春生[1] 俞冰[2] 王成林[3] 申大光[4] 

机构地区：[1]广州中医药大学深圳附属医院影像科 [2]广州中医药大学深圳附属医院药剂科 [3]北京大学深圳医院影像中心 [4]深圳市罗湖医院影像中心

出　　处：《中国CT和MRI杂志》2005年第2期4-6,16,共4页Chinese Journal of CT and MRI

基　　金：深圳市科技计划立项课题(课题编号:200404111)

摘　　要：目的评价螺旋CT血管造影(SCTA)对脑血管痉挛(CV)检出的临床应用价值。方法急性蛛网膜下腔出血(SAH)患者12例,出血停止后5～10d行SCTA检查,最大密度投影(MIP)及表面遮盖法(SSD)三维成像后处理。数字减影血管造影(DSA)在SCTA后24h内进行。观察测量6个脑动脉位置:颈内动脉鞍上段、大脑中动脉M1、M2段,大脑前动脉A1、A2段及基底动脉的直径。根据管腔直径将脑血管分为无狭窄、轻度狭窄(管腔缩小<30%)、中度狭窄(管腔缩小30%～50%)、重度狭窄(管腔缩小>50%)。比较SCTA与DSA对CV的检出情况。结果SCTA与DSA对CV检出相关因子为0.78,但对近端血管相关性好过远端血管(0.83～1.00:0.18～0.54)。对无狭窄(91%)及严重狭窄(100%)的检出与DSA的相关程度高,对轻度狭窄(56%)及中度狭窄(75%)相关程度差。结论SCTA对近端血管无狭窄或者严重狭窄诊断准确性高,对远端血管轻度狭窄的诊断准确性较差。Objective To evaluate application of spiral CT angiogrphy (SCTA) to detecting cerebral vasospasm in clinics. Methods Twelve patients with SAH due to acute subarachnoid hemorrage(SAH) underwent SCTA 5～10d later after cease-bleeding,and digital subtraction angiography (DSA) was conducted within 24 h after completion of SCTA.Maximum intensity projection(MIP) and surface shaded display(SSD) 3D images were produced for each SCTA.Six arterial locations were examined:the suprasellar internal carotid artery (ICA),the M1 and M2 segments of the middle cerebral artery(MCA),the A1 and A2 segments of the anterior cerebral artery(ACA),and the basilar artery (BA).Vasospasm was cat- egorized as none, mild(<30% luminal reduction),moderate (30% to 50% reduction),or severe (>50% reduction).A comparison between SCTA and DSA in terms of efficacy for detecting CV was conducted. Results Overall correlation coefficient between efficacies of SCTA and DSA was 0.78,and the correlation was superior in proximal locations to distal (0.83～1.00 versus 0.18～0.54). Agreement between SCTA and DSA was greater for no spasm (91%) and severe spasm (100%) than for mild (56%) or moderate (75%) spasm. Conclusion SCTA is highly effective in detecting no spasm or severe cerebral vasospasm in proximal arterial locations;and less effective for detecting mild and moderate spasm in distall ocations.

关 键 词：狭窄 SCTA 临床应用 DSA 轻度 螺旋CT血管造影 检出 脑血管痉挛 中度 管腔 

分 类 号：R743[医药卫生—神经病学与精神病学] R816[医药卫生—临床医学]