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目的 探讨仿真 3D CT血管内镜成像对脑动脉瘤的诊断价值和临床意义。方法 连续收集记载完整的 4 6例自发性蛛网膜下腔出血患者 ,其中男 2 9例 ,女 17例 ,年龄 17～ 6 9岁 ,平均 ( 4 5 .3± 13.0 )岁 ,并均行多层面螺旋CT三维血管造影 ( 3D MSCTA)和DSA检查。采用遮盖容积重建 (SVR)、多层面重建(MPR)和仿真 3D CT血管内镜 (Fly around ,Fly through)三种后处理技术 ,所得 3D MSCTA和DSA图像分别由 2位放射科医生和 2位神经科医生采用双盲法进行评价。结果 Fly around成像方法共检出 37例患者的 39个脑动脉瘤 ,并经DSA和 /或手术证实。SVR、Fly around和DSA三者对脑动脉瘤的检出率分别为93%、98%和 95 % ,它们之间无显著性差异 (P >0 .0 5 )。Fly around图像显示 6例单发的动脉瘤内附壁血栓( 6 / 39) ,瘤体直径范围为 9.5～ 19.9mm。结论 仿真 3D CT血管内镜成像技术在诊断脑动脉瘤方面具有无创性、高敏感性和准确性。对疑似脑动脉瘤患者可首选 3D MSCTA检查 ,且应把仿真 3D CT血管内镜列为常规 ,它还能清晰地显示血管腔内结构和瘤腔内血栓。
Objective To investigate the diagnostic value and clinical significance of simulated 3D CT endoscopic angiography in cerebral aneurysm. Methods A total of 46 patients with spontaneous subarachnoid hemorrhage were enrolled, including 29 males and 17 females, aged from 17 to 69 years with an average of (45.3 ± 13.0) years old Thoracic spiral CT three-dimensional angiography (3D MSCTA) and DSA. Three kinds of post-treatment techniques, covering volume reconstruction (SVR), multi-level reconstruction (MPR) and simulated 3DCT (Fly around, Fly through), were used. The obtained 3D MSCTA and DSA images were obtained by two radiologists and two Neurologist evaluated by double-blind method. Results A total of 39 cerebral aneurysms in 37 patients were detected by Fly around imaging and confirmed by DSA and / or surgery. The detection rates of SVR, Fly around and DSA for cerebral aneurysms were 93%, 98% and 95% respectively, with no significant difference (P> 0.05). Fly around images showed 6 cases of single wall aneurysm with thrombus (6/39), tumor diameter range of 9.5 ~ 19.9mm. Conclusion The simulation of 3D CT angiography in the diagnosis of cerebral aneurysms with noninvasive, high sensitivity and accuracy. For patients with suspected cerebral aneurysm, the 3D MSCTA is the first choice and the 3D CT endoscopy should be used as a routine. It can also clearly show the intraluminal structure and the thrombus in the tumor.