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数字减影血管造影联合CT血管成像对颅内动脉瘤的诊治探讨*

作者: 闵晓黎1,3 曹 毅2 何 敬3 杨 燕3 万启南3 万春平3 何国祥4

所属单位:1.云南中医学院临床学院西医内科 教研室 (云南 昆明 650500) 2.昆明医科大学第二附属医院神经 外科 (云南 昆明 650101) 3.云南中医学院第一附属医院放射 科 (云南 昆明 650021) 4.丽江市医院神经内科 (云南 丽江 674100)

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摘要

目的 探讨数字减影血管造影 联合CT血管成像对颅内动脉瘤的诊治价 值。方法 回顾性分析经数字减影血管造 影确诊为颅内动脉瘤的62例患者的颅脑 3D-DSA及CTA检查资料,观察动脉瘤部 位、形态、大小、瘤体颈比、与载瘤动 脉的关系以及动脉瘤与邻近神经、颅骨 等其他组织结构的关系等。结果 经3DDSA检出动脉瘤54例(60个),检出率约 87.1%(54/62);经CTA检出动脉瘤50例 (50个),检出率约80.7%(50/62),两者比 较无统计学差异。3D-DSA能较清晰显示动 脉瘤瘤颈的大小及瘤体与载瘤动脉的关 系,显示率达100%(60/60),并能较好显 示动脉瘤穿支血管。而CTA对动脉瘤的显 示除颈内动脉有统计学差异外,颅内其余 部位血管显示率无统计学差异,而对动 脉瘤穿支血管显示能力较差。结论 个性 化检查和两者的综合运用能充分发挥优 势,对于提高动脉瘤的诊治水平具有重要 的价值。

Objective To investigate the value of digital subtraction angiography and CT angiography in the diagnosis and treatment of intracranial aneurysms. Methods The3DDSA and CTA data of 62 patients with intracranial aneurysm diagnosed by DSA were retrospectively analyzed, the aneurysm location, shape, size and neck/body ratio were measured, as well the relationship between the aneurysm and the aneurysm bearing artery, the aneurysm and the adjacent structures such as nerve and the skull were evaluated. Results The totalof 54 cases (60 aneurysms) were detected by 3D-DSA and the relevance rate was about 87.1% (54/62), while for CTA there were 50 cases (50 aneurysms) detected and the relevance rate was about 80.7% (50/62). There is no statistical difference between the relevance rate detected by the two methods. On the other side, 3D-DSA can clearly show the size of aneurysm neck and the relationship between the aneurysm and the aneurysm bearing artery, the display rate was reached to 100% (60/60), and also can better display the perforator vessels of aneurysm. While for CTA, the display rate of aneurysm located in the internal carotid artery showed a significant difference but not for that located in the intracranial vascular, and has a poorer ability to display the perforator vessels of aneurysm. Conclusion Personalized alternation and the comprehensive application of the both methods can give full play to their respective advantages, which will be important for improving the level of diagnosis and treatment of aneurysm.

【关键词】颅内动脉瘤;数字减影血管 造影;CT血管成像

【中图分类号】R445.3;R743.4

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.02.012

前言

颅内动脉瘤(intracranial aneurysms,IA)是常见的血管性病 变危急重症之一,在脑血管意外患者中仅次于脑血栓形成、高血压 脑出血,占第3位[1]。若动脉瘤破裂造成蛛网膜下腔出血则有较高的 致残率及病死率。及早确诊及有效治疗对降低患者死亡率、改善生 活质量有十分重要的意义。目前,常用的影像学检查方法为:CT血 管造影(computed tomography angiography,CTA)、二维数字减影 血管造影(2-dimensional digital subtraction angiography,2DDSA)、三维数字减影血管造影(3-dimensional digital subtraction angiography,3D-DSA)及磁共振血管造影(magnetic resonance angiography,MRA)。本文分析我院62例采用三维数字减影血管造影 (3D-DSA)联合CT血管成像(CTA)对颅内动脉瘤的诊治,探讨临床工作中 如何科学地综合性运用常用影像检查设备及方法。