CT血管造影在颅内破裂动脉瘤诊治中的应用  

Application of computed tomographic angiography in the diagnosis and treatment of ruptured intracranial aneurysms

作　　者：丁勇[1] 刘卫东[1] 钱忠心[1] 叶树铭[1] 朱景伟[1] 张宇一[1] 陈前丽[2] 徐仕康[2] 

机构地区：[1]上海市浦南医院神经外科,200125 [2]上海市浦南医院放射科,200125

出　　处：《中国神经免疫学和神经病学杂志》2011年第5期343-346,共4页Chinese Journal of Neuroimmunology and Neurology

基　　金：上海市浦东新区卫生系统中青年业务骨干培养资助项目(2009年)

摘　　要：目的评估CT血管造影(CTA)在颅内破裂动脉瘤临床诊治中的应用价值。方法回顾性分析72例以蛛网膜下腔出血发病入院的颅内破裂动脉瘤患者的影像学资料及手术情况。结果 72例患者经DSA检查及手术中共发现81个动脉瘤。CTA检查共发现动脉瘤79个,其中破裂动脉瘤71个、未破裂动脉瘤8个,其检出敏感性97.5%(79/81);漏诊颈内动脉床突旁的未破裂微小动脉瘤和椎动脉破裂的夹层动脉瘤各1个。CTA提供的动脉瘤瘤径、动脉瘤深径以及动脉瘤最大径与DSA检查比较差异无统计学意义(P>0.05)。CTA在动脉瘤的指向、瘤颈部位、毗邻血管显示方面良好,尤其显示动脉瘤与骨结构的空间关系上优于DSA。结论 CTA是一种快捷、无创的脑血管检查方法,能迅速提供颅内破裂动脉瘤的确切信息,对动脉瘤的夹闭或栓塞手术具有重要的指导价值。Objective To assess the values of computed tomographic angiography （CTA） in the diagnosis and treatment of ruptured intracranial aneurysm. Methods Seventy-two patients who had ruptured intracranial aneurysms and underwent clipping or coil embolism were retrospectively analysed. All the patients performed CTA, and once aneurysm was found, treatment decision was made quickly. The differences among the findings in CTA, DSA and operation were analyzed. Results 81 aneurysms were found in the 72 cases. CTA revealed 71 ruptured aneurysms and 8 unrupture aneurysms, reaching the sensitivity of 97.5%. One small paraclinoid internal carotid artery aneurysm and 1 vertebral artery dissecting aneurysm were missed. CTA could shown three-dimensional structure of aneurysm. There was no significant difference regarding the size of aneurysmal neck and sac measured in CTA, DSA and operation directly （P〉0.05）. CTA provided good view on aneurysmal direction, neck and the spatial relation between aneurysm and their adjacent vessels. CTA was superior to DSA in presenting the spatial relation between aneurysm and their adjacent bony structures. Conclusions CTA is a quick, reliable and noninvasive method. It can quickly provide clear information of aneurysms, which became the guidance for clipping or coiling of intraeranial aneurysms.

关 键 词：脑血管造影术 血管造影术 数字减影 颅内动脉瘤 蛛网膜下腔出血 

分 类 号：R651.12[医药卫生—外科学] R743.4[医药卫生—临床医学]