三维CT血管成像在颅内动静脉畸形诊治中的价值  

Clinical application of 3D CTA in the diagnosis and treatment of intracranial arteriovenous malformations

作　　者：陈旭[1] 胡海菁[2] 刘成辉[1] 李春芳[2] 林启明[1] 梁世行[1] 

机构地区：[1]南方医科大学附属佛山市南海区人民医院神经外科,528200 [2]南方医科大学附属佛山市南海区人民医院放射科,528200

出　　处：《中国脑血管病杂志》2009年第4期198-202,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨三维CT脑血管成像（CTA）在颅内动静脉畸形（AVM）诊治中的价值。方法采用8排螺旋CT及静脉注射非离子型对比剂进行头部螺旋容积扫描，分析23例AVM的CT平扫、增强的影像表现，利用血管生成及图像融合技术对病变进行容积重建。依据CTA检查结果，对15例颅内AVM的患者进行手术病灶切除。通过手术所见，评价三维CTA对AVM的诊断和手术治疗的指导价值。结果行CTA检查发现23例25处AVM，手术切除AVM病灶15处。①手术中发现AVM的位置与三维CTA检查结果完全一致，符合率为100％。②三维CTA对供血动脉显示率为91．9％（34／37），其中3例因供血动脉纤细、走行弯曲显示不清；引流静脉的显示率为77．8％，其中4例（6支）引流静脉因弯曲、血管团及供血动脉重叠，显示不清。18例引流静脉及所导入的静脉窦同时显影。③三维CTA检测15处畸形血管团平均累及范围为（13．75±0．48）cm^2；术中测量为（13．51±0．52）cm^2，CTA与手术结果比较，差异无统计学意义（P〉0．05）。结论多排螺旋CT血管成像技术可清晰完整地显示AVM的准确位置、畸形血管团、病灶范围、供血动脉、引流静脉全程及邻近组织的三维影像，能够提供手术所需的重要信息。Objective To investigate the value of three-dimensional multi-slice spiral CT angiography （3D-CTA） and image fusion technology in the diagnosis and treatment of intracranial arteriovenous malformations （AVM）. Methods The 8-slice spiral CT and 80 - 100 ml of non-ionic contrast agent injection were applied in 23 patients with AVM. Both of the plain and contrast CT images, arterial and venous phases, threedimensional reconstruction with inultiplanar volume reformation （ MPVR ） , and volume rendering （ VR ） were used synchronously to evaluate the 3D-CTA in the diagnosis and treatment of AVM. Results CTA showed 25 AVMs in 23 patients, and 15 AVMs were resected. （1） Of the 15 resected AVMs, the positions of malformation vascular niduses in operation were completely consistent with the results of CTA, with the coincidence rate of 100%. （2） 91.9% （34/37） of the feeding arteries were showed by 3D-CTA, and 3 of the arteries were unclear because of these arteries were too slim and tortuous ; 77.8% of the draining veins were showed by 3D-CTA, and 6 of the veins were unclear because these veins were tortuous and overlapped with the AVM nidus and feeding artery, and in 18 cases the venous sinuses and the drainage veins were visualized simultaneously. （3） The mean area involved by the AVM nidus in the 15 resected AVMs evaluated with 3D-CTA was 13.75 ±0. 48cm^2 , while the mean area measured during operation was 13.51 ±0. 52 cm^2, there were no significant difference between the two measurements （ P 〈 0. 05 ）. Conclusions 3D-CTA technology can clearly and completely show the position of AVM nidus, the extent of lesion, the feeding arteries , the drainage veins, and the 3D image of adjacent tissues, so it can provide important informations for operation of AVM.

关 键 词：颅内动静脉畸形 体层摄影术 螺旋计算机 脑血管造影术 

分 类 号：R743.4[医药卫生—神经病学与精神病学] R445.3[医药卫生—临床医学]