【作者】 董印；

【导师】 李刚；

【作者基本信息】 山东大学 ， 外科学， 2006， 硕士

【摘要】 目的 通过比较诊断颅内动脉瘤的两种主要影像学检查方法—CT脑血管造影(CTA)、数字减影脑血管造影(DSA)—的优缺点及其分别对制订治疗方案的指导意义，探讨CTA、DSA在颅内动脉瘤的诊断及治疗中的应用价值，为临床工作中根据病变部位、病情轻重选择合适的检查方法提供一定参考。 方法 选择因自发性蛛网膜下腔出血或一侧动眼神经麻痹，疑为颅内动脉瘤的病人11例，术前均行CTA及DSA检查。CTA采用德国西门子公司16层螺旋CT，扫描方式均为单螺旋连续薄层扫描，重建方式为表面成像法(SSD)、最大密度投影成像法(MIP)。DSA采用德国西门子公司1200mA数字X线摄影机DR，经股动脉穿刺插管全脑血管造影，每个系列行多角度投照，至病灶显示满意为止。 结果 CTA检查显示：11例病人共检出10个动脉瘤并经手术证实，1例经DSA检查证实为假阴性。DSA检查显示：前交通动脉瘤8例，大脑前动脉瘤1例，颈内动脉-后交通动脉瘤2例，大脑中动脉瘤1例。1例病例在全麻下行小脑后下动脉动脉瘤栓塞术，1例病人在全麻下行前交通动脉动脉瘤栓塞术，其余病例在全麻下行显微神经外科动脉瘤颈夹闭术。11例病人的11个动脉瘤均为一次手术治疗完成。CTA显示的病变形态结构与术中所见完全符合。1例后交通动脉瘤病人DSA检查瘤颈显示不清，难以夹闭，但在CTA检查中显示清晰，手术探查结果与CTA所示更接近。1例前交通动脉瘤病人术后因一过性偏瘫复查CTA，双侧大脑前动脉显影良好，经康复治疗，治愈出院。更多还原

【Abstract】 Objective: To assess the different value of computered tomographic angiography (CTA) and digital subtraction angiography (DSA) in the diagnosis and preoperative evaluation of intracranial aneurysms, to evaluate how much influence both of these methods exerted on clinical treatment of intracranial aneurysms, and make sure how to choose a suitable method to find intracranial aneurysms.Methods: Computered tomographic angiography (CTA) study and conventional digital subtract angiography (DSA) were performed on eleven patients who were suspected bearing intracranial aneurysms according to clinical manifestations such as headache, vomiting, neck stiffness and CT scan results after admission. Aneurysms were analyzed for size of their bodies, necks and their relationships with the patent arteries and the surrounding cranial bone structures. All the cases were confirmed by operation.Results: Out of the eleven cases, ten aneurysms were detected by CTA and confirmed by DSA and the following operation. One pseudo-negative aneurysm of CTA was determined by DSA and the following operation. CTA can depicture the three dimensional anatomy structures of the cerebral arteries and supply useful information for the diagnosis and treatment of intracranial aneurysms. The neck of aneurysms and relationships between the aneurysms and their patent arteries were clearly demonstrated. Out of the eleven positive cases, two was performed interventional embolization, other cases underwent clipping surgery. CTA was performed for one case that suffered from temporary hemi paralysis after clipping of the anterior communicating artery aneurysm,更多还原