【作者】 刘健； 出良钊； 杨华； 范光明； 隋建美； 董明昊； 赵兵； 王凡；

【机构】 贵阳医学院附属医院神经外科；

【摘要】 目的探讨三维CT血管造影(3D-CTA)对颅内动脉瘤的诊断价值,以及对动脉瘤夹闭术后评价其指导价值。资料与方法回顾性分析32例临床怀疑为颅内动脉瘤,并进行了CTA和DSA检查的病例,以DSA作为参考标准,评价 3D-CTA诊断价值。搜集5例动脉瘤钛夹夹闭病例进行术后评价,术前术后均进行了CTA检查,通过比较两次CTA结果评价动脉瘤夹闭情况。结果根据DSA资料及手术结果,CTA发现颅内动脉瘤的敏感性为100％,特异性为100％,准确性为 93．9％。5例动脉瘤钛夹夹闭术后CTA随访中,与术前CTA相比,颅内大血管均未见狭窄或闭塞。结论 3D-CTA诊断颅内动脉瘤具有较好的特异性和敏感性,以及较好的三维显示能力,是一种可靠、无创的快速诊断颅内动脉瘤的方法,为手术提供了详实的影像学资料,可帮助制定治疗方案。但对颈内和椎动脉动脉瘤,CTA仍然存在着一定难度。在动脉瘤夹闭术后评价方面,CTA能够清楚地显示瘤夹位置及载瘤动脉的通畅程度,但对于判断瘤颈及瘤体残留方面,其准确性有待进一步证实。更多还原

【Abstract】 Objective To assess the values of 3D-CT angiography (CTA) in the diagnosis and operative follow up of intracranial aneurysms after clip. Materials and Methods 32 patients were admitted under clinical symptoms and signs sugges tive of harboring intracranial aneurysms. All these patients were underwent CTA and DSA examinations. DSA was used as gold standard. 6 patients who had been treated with clip were underwent both preoperative and postoperative CTA to evaluate aneurysm clipping. Results According to DSA results and surgical findings , the sensitivity , specificity , and the accuracy of 16 slices CTA for the detection of all aneurysms were 100 % , 100 % , and 93. 9 % respectively. Postoperative CTA displayed a remnant of the aneurysm body in one case , and all the parent artery and other major artery are patency. Conclusion 3D-CTA has satisfying sensitivity and specificity , that is a quick , reliable , and relatively noninvasive diagnostic tool for intracranial aneurysms , 3D-CTA with-VR delineates the aneurysmal morphology in detail , and provides useful information for choosing and planning microsurgical or endovascular treatment. But CTA has limitation in internal carotid artery and vertebral artery. After aneurysm clipping , CTA can evaluate clip position , the patency of the parent vessel and other major vessel , but the value of evaluating the presence of remnant of aneurysm body and neck need further research.更多还原