3D-CTA在颅内前循环动脉动脉瘤临床诊疗中的应用  

Application of 3D-CTA in the clinical diagnosis of intracranial anterior circulation aneurysm

作　　者：李祥[1] 于如同[1] 谷佳[1] 张旭 孟庆明[1] 

机构地区：[1]徐州医学院附属医院神经外科,221000

出　　处：《中华神经外科杂志》2015年第6期557-559,共3页Chinese Journal of Neurosurgery

基　　金：：国家“十二五”科技支撑计划子课题（2011BA108806）

摘　　要：目的 评价3D-CTA在颅内前循环动脉动脉瘤临床诊疗中的作用.方法 回顾性分析2004年6月至2014年6月徐州医学院附属医院神经外科收治的322例前循环动脉动脉瘤患者的3D-CTA、3D-DSA和手术资料.其中有8例3D-CTA显示不清而改行3D-DSA检查;35例手术后应用3D-CTA进行复查.3D-CTA图像采用多层平面重建（MPR）、最大信号密度投影（MIP）、容积再现（VR）、仿真内镜技术（VE）4种处理技术.结果 314例患者3D-CTA显示317个动脉瘤（有3例为多发动脉瘤）;另外8例3D-CTA显示不清而改行3D-DSA检查后则能清晰地显示动脉瘤.322例均予开颅显微手术夹闭动脉瘤,术中所见与影像结果一致;有35例手术后6个月行3D-CTA复查显示动脉瘤完全夹闭.结论 3D-CTA是检查颅内动脉瘤高度敏感的无创影像手段,可以作为动脉瘤首选的影像学诊断方法;3D-CTA阴性的蛛网膜下腔出血患者应行DSA检查,以避免漏诊;3D-CTA检查可作为动脉瘤术后随访的首选方法.Objective To assess the roles of 3D-CTA in the clinical diagnosis of intracranial anterior circulation aneurysm.Methods The 3D-CTA,3D-DSA and operation data of 322 patients with anterior circulation aneurysm admitted to the Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical College from June 2004 to June 2014 were analyzed retrospectively.3D-CTA in 8 patients showed unclear and had to perform 3D-CTA examination; and 35 patients were examined by using 3D-CTA after procedure.Four processing techniques of 3D-CTA image were used,including multi-planar reconstruction （MPR）,maximum signal intensity projection （MIP）,volume rendering （VR）,and virtual endoscopy （VE）.Results 3D-CTA revealed 317 aneurysms in 314 patients （3 were multiple aneurysms）.3D-CTA showed unclear in the other 8 patients and it clearly showed the aneurysms after they performed 3D-DSA examination.Three hundred twenty-two patients were treated with craniotomy and microsurgical clipping of aneurysms.Surgery and imaging results were consistent.3D-CTA showed that the aneurysms of 35 patients were clipped completely at 6 month after procedure.Conclusions 3D-CTA is a highly sensitive non-invasive imaging means for detecting intracranial aneurysms.It can be used as the first choice of imaging diagnosis for aneurysms.3D-CTA negative patients with subarachnoid hemorrhage should perform DSA examination in order to avoid misdiagnosis.3D-CTA examination can be used as the preferred method for follow-up after surgery.

关 键 词：颅内动脉瘤 血管造影术 数字减影 体层摄影术 X线计算机 显微外科手术 

分 类 号：R651.1[医药卫生—外科学]