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目的:评价3D-SCTA对颅内动脉瘤的临床应用价值。方法:DSA检查诊为颅内动脉瘤,但瘤颈、载瘤动脉或瘤体立体形态显示不满意的患者11例,行3D-SCTA检查,重建方法采用最大强度投影(MIP)和表面遮盖成像(SSD)。全部病例均经手术证实。结果:11例术中共发现15个动脉瘤,螺旋CT血管造影及三维重建与DSA均检出14个动脉瘤,漏诊1个脉络膜前动脉瘤,检出率为933%。在DSA检出的14个动脉瘤中,12个动脉瘤的瘤颈显示不满意,3D-SCTASSD图像全部得以明确;10个动脉瘤的载瘤动脉显示不理想,在3D-SCTASSD上可清晰显示8个,1个脉络膜前动脉起始部动脉瘤和1个后交通动脉起始部动脉瘤未能明确显示。SSD图像可使血管和颅骨同时显示,但对小血管的显示不及DSA,DSA正常显示的后交通动脉约30%在3D-SCTA上未显示。SSD图像可清晰显示动脉瘤颈部的解剖关系、载瘤动脉、邻近血管及周围骨结构。结论:螺旋CT血管造影及三维重建对Willis环周围瘤体大于4mm的颅内动脉瘤可达到与DSA同样的检出率,可以明确DSA显示不理想的动脉瘤的瘤颈、载瘤动脉情况,但对瘤周小血管的显示不及DSA。
Objective: To evaluate the clinical value of 3D-SCTA for intracranial aneurysms. Methods: DSA was performed in 11 patients with intracranial aneurysm, but the tumors, tumor-bearing arteries or tumors showed unsatisfactory stereoscopic morphology. 3D-SCTA was used for the reconstruction. The maximum intensity projection (MIP) and surface occlusion imaging (SSD). All cases were confirmed by surgery. Results: A total of 15 aneurysms were found in 11 cases. 14 aneurysms were detected by spiral CT angiography, three-dimensional reconstruction and DSA. One anterior choroidal aneurysm was missed, the detection rate was 933%. Among the 14 aneurysms detected by DSA, aneurysms of 12 aneurysms showed unsatisfactory neoplasms, and all 3D-SCTASSD images were clear. The aneurysms of 10 aneurysms showed unsatisfactory results and were clearly displayed on 3D-SCTASSD Eight aneurysms at the anterior part of the anterior pre-choroidal artery and aneurysms at the beginning of the posterior communicating artery failed to be clearly shown. The SSD image shows both the blood vessel and the skull simultaneously, but not as small a vessel as the DSA. About 30% of the posterior communicating artery normally displayed by the DSA is not shown on the 3D-SCTA. The SSD image clearly shows the anatomy of the aneurysm neck, the parent artery, adjacent blood vessels and the surrounding bone structure. Conclusion: Spiral CT angiography and 3D reconstruction of intracranial aneurysms larger than 4mm around Willis ring can achieve the same detection rate as DSA, which can confirm the aneurysm tumor neck and parent artery which DSA shows poorly, However, the small tumor of the tumor showed less than DSA.