3D-DSA对颅内微小动脉瘤的诊断价值及对治疗指导意义的探讨  

Clinical Value of 3D-DSA in the Assessment of Very Small Cerebral Aneurysms and Therapeutic Directions

作　　者：蔡红法[1] 张栋[1] 刘一之[1] 倪才方[1] 

机构地区：[1]苏州大学附属第一医院介入科,江苏215006

出　　处：《当代医学》2012年第6期8-10,共3页Contemporary Medicine

摘　　要：目的探讨3D-DSA对颅内微小动脉瘤(最大径≤3mm)(Very Small Cerebral Aneurysms,VSCAs)的诊断价值以及对治疗的指导意义。方法回顾分析自2010年12月至2011年8月间66例蛛网膜下腔出血患者脑血管造影资料,所有患者均行常规DSA(正侧位+各种斜位)及二维旋转DSA造影,并经3D-DSA重建,包括表面阴影重建(SSD),最大密度投影(MIP),容积再现(VR)。结果 66例患者中发现39例共50枚动脉瘤(阳性率59.09%),其中VSCAs占10例11枚(占动脉瘤总数的22.00%),位于颈内动脉后交通段6枚,眼动脉段、前交通动脉、大脑后动脉、小脑后下动脉及小脑前下动脉各1枚。其中,6例行动脉瘤夹闭术,4例行血管内栓塞治疗。所有VSCAs在3D-DSA下均清楚暴露瘤体、瘤颈、载瘤动脉、动脉瘤的形状和大小及其与邻近解剖结构的关系。结论 3D-DSA在显示动脉瘤特别是直径小于3的微小动脉瘤的载瘤动脉的走向、动脉瘤的大小、形态、瘤体的长短径、瘤颈显示、瘤颈的宽窄及瘤颈与载瘤动脉的关系等方面有着显著地优势,使用3D-DSA能更正确判断微小动脉瘤血管内治疗的可行性,准确选择第1枚弹簧圈,并准确判断动脉瘤的栓塞程度。Objective To evaluate the clinical value of 3D-DSA in the assessment of very small cerebral aneurysms（VSCAs） and therapeutic directions. Methods A total of 66 patients with acute subarachnoid hemorrhage or headache due to ruptured aneurysm underwent angiography with both 2D DSA and 3D-DSA（Three-dimensional Rotational angiography）, DSA was performed in two to six standard projections in every vascular territory. Three-dimensional RA datasets were evaluated by using surface-shaded display, maximum intensity projection and volume rendering. Results Thirty-nine cases of 66 patients were diagnosed with intracranial aneurysm, and totally 50 aneurysms were found, including 11 VSCAs of 10 cases patients. The characteristics of VSCAs （shape, size, visibilities of both aneurismal neck and its relation to parent artery ）were demonstrated clearly with 3D-DSA. Conclusion Comparing with 2D-DSA, 3D-DSA can clearly depicted the VSCAs shape, neck and its relation to parent artery,3D-DSA can help Correctly judging the feasibility of endovascular treatment, correctly choosing the first coil and judging the degree of embolization.

关 键 词：3D-DSA 微小动脉瘤 颅内微小动脉瘤 蛛网膜下腔出血 介入 

分 类 号：R743[医药卫生—神经病学与精神病学]