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目的 总结磁共振血管造影术诊断和手术治疗颅内动脉瘤的方法。方法 25例经CT诊断为蛛网膜下腔出血的患者施行磁共振血管造影术,扫描范围包括双侧椎动脉颅内段和颈内动脉岩骨段部位。出血后首次行磁共振血管造影术的时间为4h～50d,平均10.9d;手术前Hunt-Hess分级为Ⅰ级4例,Ⅱ级11例,Ⅲ级4例,Ⅳ级5例和Ⅴ级1例。结果 25例患者中,首次磁共振血管造影阳性者18例,2例有伪影者经再次复查证实,共检出22个动脉瘤;4例阴性;1例可疑者经脑血管造影证实。20例磁共振血管造影阳性患者,16例经手术证实。GOS评估良好16例,中残2例,重残2例,昏迷4例,死亡1例。结论 应用磁共振血管造影检查诊断颅内动脉瘤,阳性检出率较高,假阳性率低,对不具备脑血管造影设备的医疗单位具有一定应用价值。
Objective To summarize the methods of magnetic resonance angiography and surgical treatment of intracranial aneurysms. Methods Twenty-five patients diagnosed as subarachnoid hemorrhage by CT underwent magnetic resonance angiography. The scope of scanning included the parts of the petrous bone in the intracranial and internal carotid arteries of bilateral vertebral arteries. The first magnetic resonance angiography was performed within 4 h to 50 d after hemorrhage (averaged 10.9 days). Preoperative Hunt-Hess grade Ⅰ was 4 cases, Ⅱ grade 11 cases, Ⅲ grade 4 cases, Ⅳ grade 5 and Ⅴ grade 1 example. Results Of the 25 patients, 18 were diagnosed by first magnetic resonance angiography, and 2 were confirmed by retrospective examination. A total of 22 aneurysms were detected, 4 were negative, and 1 was suspected by cerebral angiography. Twenty patients with positive magnetic resonance angiography were confirmed by operation. GOS assessment of good 16 cases, 2 cases of disability, severe disability in 2 cases, coma in 4 cases, 1 case of death. Conclusion The diagnosis of intracranial aneurysms by magnetic resonance angiography has a high positive detection rate and a low false positive rate, which is of value in medical units that do not have cerebral angiography equipment.