CT血管造影诊断破裂脑动脉瘤  

Diagnosis of ruptured cerebral aneurysm with computerized tomography angiography

作　　者：陈铮立[1] 蔡学见[1] 钱晓凌[1] 潘功茂[1] 董吉荣[1] 房文峰[1] 刘斌[1] 时忠华[1] 徐勤谊[1] 蔡桑[1] 王标[1] 

机构地区：[1]无锡市解放军第101医院,214004

出　　处：《临床神经外科杂志》2006年第4期151-153,共3页Journal of Clinical Neurosurgery

摘　　要：目的探讨运用cT血管造影（CTA）诊断破裂脑动脉瘤。方法对怀疑颅内动脉瘤破裂的16例病人施行CTA检查，采用Philips Tomoscan AVP1螺旋CT机，120kV，200mAs，层厚1．5mm，螺距1．重建间隔0．05mm。造影剂为欧乃派克100ml，2．5—3．0ml／s的速度经肘正中静脉注入，16—18s后扫描。数据经计算机工作站处理后以MIP和SSD法显示，由放射科医师和神经外科医师共同阅片。结果本组16例病人共检出13例16个动脉瘤，其中前交通动脉瘤8例，后交通动脉瘤1例，基底动脉梭形动脉瘤1例，左侧大脑中动脉瘤破裂合并右侧颈内动脉瘤1例，后交通动脉瘤合并同侧颈内动脉床突周围段芽孢状微小动脉瘤2例。10例脑动脉瘤做了开颅手术治疗，术后恢复良好5例，生活自理2例，重度残废2例，植物生存1例。未手术的3例病人，其中1例Hunt-HessV级者术前准备时死亡，1例放弃治疗死亡。1例基底动脉梭形膨大者保守治疗，遗有脑干受压症状。结论CTA具有快速、简便、安全、可靠的优点，可作为破裂脑动脉瘤和急诊手术前首选的检查。Objective To evaluate the value of computerized tomography angiography （CTA） for the diagnosis of ruptured cerebral aneurysm. Methods 16 patients on suspicion of ruptured cerebral aneurysms had CTA with the Philips Tomoscan AVP1 spiral CT under the condition of 120 kV, 200 mAs,l.5 mm thickness,1 pitch and 0.5 mm reconstruction gap after injection of 100 ml Omnipaqu with the speed of 2.5 - 3.0 ml/s via cubitus vein. The scan delayed 16 to 18 seconds after the injection. Displayed with the techniques of maximum intensity projection （MIP） and the shaded surface display （SSD） after the data proceeded by computer station,the imagines were read both of radiology physician and neurosurgeon. Results 16 aneurysms were found in 13 cases, including 8 cases of anterior communicating arterial aneurysm （ACoA）, 1 case of posterior communicating arterial aneurysm （PCoA）, 1 case of basilar arterial aneurysm （ BA ） , 1 case of left middle cerebral artery aneurysm （ MCA ） and 2 cases of PCoA accompanied with minimum sprout-like aneurysm at collateral paraclinoid carotid artery. There were 3 cases of negative finding, including spontaneous hemorrhage in ventricle, spontaneous subaraehnoid hemorrhage （SAH） and traumatic subarachnoid hemorrhage. In 10 operated patients, 5 achieved good recovery, 2 self-care, 2 severe disability and 1 was survival vegetable, 3 patients had conservative treatment. One of Hunt-Hess V died before operation. One died of giving up treatment. And one with BA survives with the symptoms of brain stem compression. Conclusion CTA may be a quick, relative simple, safe and reliable tool of choice for the diagnosis and emergency treatment of ruptured aneurysm.

关 键 词：脑动脉瘤 CTA 蛛网膜下腔出血 诊断 

分 类 号：R743[医药卫生—神经病学与精神病学]