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目的探讨三维CT血管造影(three di mensional computed tomographic angiography,3D-CTA)在颅内动脉瘤的临床应用及其价值。方法对自发性蛛网膜下腔出血及怀疑颅内动脉瘤的患者53例,使用SIEMENS SOMATOMSensation16层螺旋CT扫描仪行3D-CTA检查(时间在发病后4h~3d),并行数字减影血管造影(digital subtraction angiography,DSA)检查;3D-CTA图像与DSA图像由神经外科医师和放射科医师用双盲法共同进行分析。结果经3D-CTA、DSA和手术共同证实发现44例共49个动脉瘤,动脉瘤大小为1.7~25mm,其中单发动脉瘤36例,多发5例(1例为3个动脉瘤,4例为2个动脉瘤);在44例动脉瘤患者中3D-CTA发现42例47个动脉瘤;DSA发现43例48个动脉瘤;动脉瘤的瘤体最大径及瘤颈最大径3D-CTA测量值与DSA测量值比较无显著性差异(t=0.59和t=0.49,P均>0.05);53例病情轻重不一患者在行3D-CTA检查过程中病情无加重或无其他意外发生。结论3D-CTA对颅内动脉瘤具有快捷、经济、安全和微创等优点,并有通过一次注射对比剂扫描即可从任意角度观察所显示的颅内动脉瘤的细节及与骨性结构的关系等优点,但存在无法依时间顺序分别显示动脉、毛细血管和静脉,无法分清血流方向及显示一些重要的小血管和重要的穿通支如脉络膜前动脉、丘脑穿通动脉等,也无法在血管内操作等不足之处;在诊断和治疗颅内动脉瘤的应用中与DSA检查互补也可得到颅内动脉瘤更完整的信息。
Objective To investigate the clinical application and value of three-dimensional computed tomography angiography (3D-CTA) in intracranial aneurysms. Methods Fifty-three patients with spontaneous subarachnoid hemorrhage and suspected intracranial aneurysms were examined by 3D-CTA with SIEMENS SOMATOMSensation 16-slice spiral CT scanner (time 4h-3d after onset) and digital subtraction angiography digital subtraction angiography, DSA); 3D-CTA images and DSA images were analyzed by both the neurosurgeon and the radiologist using a double-blind method. Results A total of 44 aneurysms were found in 44 patients. The size of the aneurysm was 1.7 ~ 25mm. There were 36 aneurysms and 5 multiple aneurysms (1 aneurysm in 3 and 4 aneurysms 2 aneurysms); 42 aneurysms of 42 cases were found by 3D-CTA in 44 aneurysms; 43 aneurysms were found in 43 DSAs; the largest diameter of the aneurysm and the largest diameter of the neck were measured by 3D-CTA There was no significant difference between DSA and DSA (t = 0.59 and t = 0.49, P> 0.05). No significant difference was found in 53 patients with different severity or no other accident during 3D-CTA. Conclusion 3D-CTA has the advantages of fast, economical, safe and minimally invasive for intracranial aneurysms. It can observe the details of intracranial aneurysms and the relationship with the bony structure Relationship, etc. However, there is an inability to separate the arteries, capillaries and veins in chronological order, fail to distinguish the direction of blood flow, and display some important small vessels and important perforations such as the anterior pre-choroidal artery and the thalamic penetrating artery, Internal operations and other deficiencies; in the diagnosis and treatment of intracranial aneurysms and DSA examination complementarity can also be more complete information on intracranial aneurysms.