论文部分内容阅读
目的通过将前交通动脉瘤患者的MSCTA图像资料与临床手术中所见进行对照,探讨16层螺旋CT血管造影(MSCTA)在前交通动脉瘤破裂急性期的临床应用价值。方法选取30例以蛛网膜下腔出血为首发症状,经全麻下开颅动脉瘤颈夹闭术证实的急性前交通动脉瘤破裂患者,所有患者术前均行MSCTA检查,对其CTA资料进行分析,采用(VR),最大密度投影法(MIP)和仿真内窥镜(VE)等方法进行图像重组,多角度显示脑动脉树,观察前交通动脉瘤的形状,大小,瘤颈,动脉瘤与载瘤动脉,周边血管及骨质的关系,并在CT工作站上模拟手术入路。将上述指标同手术中所见进行对比,观察其一致性。结果手术证实31处动脉瘤,CTA检出30处,敏感性为96.7%,特异性为100%.另外,CTA检出的动脉瘤内血栓9例(9/9),穿支血管6例(6/8).术前CTA清晰显示瘤体与载瘤动脉及颅骨的空间关系,与术中所见高度一致。结论MSCTA对前交通动脉瘤显示率高,与临床手术对比一致性好,在短时间内(10分钟内)即能明确动脉瘤的位置、形态、指向、轮廓、动脉瘤与载动脉血管的关系及动脉瘤径的宽度,无创、安全、快速、可靠性高,故可作为颅内动脉瘤破裂首选的筛检方法及独立指导手术治疗。
Objective To evaluate the clinical value of 16-slice spiral CT angiography (MSCTA) in the acute phase of rupture of anterior communicating aneurysms by comparing the MSCTA images of patients with anterior communicating aneurysms with the findings of clinical surgery. Methods Thirty patients with subarachnoid hemorrhage as the first symptom were enrolled in this study. All the patients underwent preoperative MSCTA before operation undergoing craniotomy and aneurysm neck rupture. All patients underwent CTA (VR), maximum density projection (MIP) and virtual endoscopy (VE) were used to perform image reconstruction. The cerebral arteries were displayed at different angles. The shape, size, neoplasms, aneurysms And the host artery, peripheral blood vessels and bone relations, and in the CT workstation simulation of surgical approach. The above indicators compared with the surgery seen to observe the consistency. Results Thirty-one aneurysms were confirmed by surgery, with a sensitivity of 96.7% and a specificity of 100% for CTA.Furthermore, there were 9 cases (9/9) of thrombus in CTA and 6 cases of perforating branches 6/8) .Preoperative CTA clearly shows the tumor and tumor-bearing arteries and the spatial relationship between the skull, and the intraoperative findings are highly consistent. Conclusion MSCTA shows a high rate of anterior communicating aneurysm, which has good consistency with clinical surgery. The location, shape, orientation, contour and the relationship between aneurysm and carotid artery can be clearly identified in a short time (within 10 minutes) And the width of aneurysm diameter, noninvasive, safe, fast, high reliability, it can be used as the screening method of intracranial aneurysm rupture and independent guidance surgery.