MSCTA在大型脑膜瘤个性化手术方案设计中的应用价值

目的:探讨多排螺旋CT血管成像(MSCTA)在设计大型脑膜瘤个性化手术方案中的应用价值.方法:对146例直径>5cm的脑膜瘤患者术前行MSCTA检查,利用三维重建图像模拟手术操作设计个性化手术方案,包括手术入路、手术术式、全切方案及术前栓塞治疗与否,以术中所见为标准评价手术方案合理性.结果:通过MSCTA模拟操作后146例患者均合理设计了个性化手术方案,其中MSCTA显示19例颅内重要动脉明显阻碍手术操作窗而改变了常规入路途径,50例瘤体模拟单纯入路由于基底较宽或入路远侧瘤体暴露困难而改为联合扩大术式,35例瘤体侵及视神经、脑干走行区或包裹颅内重要动脉提示全切风险大而术前早期制定了次全切手术方案及放疗计划,14例窦旁脑膜瘤因窦腔闭塞而制定瘤体及静脉窦全切方案,42例富血供瘤体行术前颈外动脉栓塞治疗.术中所见与模拟操作所遇情况高度一致,瘤体暴露充分、合理,有效避免了颅内重要血管、神经功能区及静脉窦的损伤,降低了并发症的发生率,瘤体切除范围理想.结论:通过MSCTA模拟手术操作可充分、准确了解术中情况,评估手术方案的合理性和风险度,协助临床医生术前制定最佳治疗方案.     

MSCT血管造影在颅底脑膜瘤手术入路及术式选择的应用

目的 探讨多排螺旋CT血管造影(MSCTA)对颅底脑膜瘤手术入路及术式选择的应用价值.方法 对本院40例颅底脑膜瘤患者术前行MSCTA检查,利用三维重建图像模拟手术操作,以术中所见为标准对照.结果 通过MSCTA模拟操作后40例患者皆合理的设计和选择了手术入路和术式,术中所见与模拟操作所遇情况高度一致,有效地避免了颅内重要血管及神经功能区的损伤,其中MSCTA显示4例颅内重要动脉明显阻碍手术操作窗而改变了常规入路途径,6例跨区生长瘤体单纯入路由于入路远侧瘤体暴露困难而改为联合扩大术式,4例瘤体侵及视神经、脑干走行区或包裹颅内重要动脉提示全切风险大而术前早期制订了次全切手术方案及放疗计划.结论 通过MSCTA模拟手术操作对指导颅底脑膜瘤临床选择最佳手术入路及术式有重要意义.     

4D-CTA联合全脑灌注成像在颅内动脉瘤术后随访中的应用价值

目的 利用4D-CTA联合全脑灌注成像的方法评估颅内动脉瘤术后血管及血流动力学改变.方法 回顾性分析49例颅内动脉瘤性蛛网膜下腔出血(SAH)术后的患者,所有患者均于发生SAH 3 ～ 14天内行全脑灌注成像检查.使用西门子公司SyngoMMWP后处理工作站,用Inspace软件重组4D-CTA图像,以VPCT Neuro软件,生成脑血流量(CBF)、血容量(CBV)、达峰时间(TTP)、延迟时间(TTD)及平均通过时间(MTT)伪彩图.在检查残余动脉瘤的同时判断有无脑血管痉挛及其他血管病变,并用灌注参数评估SAH继发的迟发性脑缺血情况及其他并发症.结果 4D-CTA共检出59个颅内动脉瘤的术后改变.其中动脉瘤夹闭术后50个,栓塞术后9个.1例前交通动脉瘤夹闭术后存在残留动脉瘤.2例患者发现颅内其他部位存在动脉瘤.4D-CTA上18例患者共28条血管出现血管痉挛.共29例患者的伪彩图上出现异常灌注区域,其中23例患者为迟发性缺血,2例患者为血管夹压迫相关脑缺血,4例患者为手术操作损伤相关脑缺血.结论 4D-CTA可清晰显示动脉瘤术后有无瘤体残留、动脉瘤夹及栓塞材料与载瘤血管的关系.4D-CTA联合全脑灌注成像可同时显示宏观上的血管痉挛及灌注上的微循环改变.全脑灌注成像可显示术后多种并发症所导致的血流动力学改变.     

颈动脉体瘤的术前造影和栓塞

目的了解颈动脉体瘤的血供情况及术前栓塞对术中出血、手术全切率和术后疗效的影响.材料与方法18例颈动脉体瘤患者行数字减影血管造影,并经5F造影导管用直径2501000μmIvalon对肿瘤供血动脉进行栓塞处理.结果颈动脉体瘤主要由同侧的颈外动脉分支供血,同侧颈内动脉参与供血的占1/18,椎动脉参与供血的占2/18.供血动脉栓塞后肿瘤染色大部分消失,术中出血明显减少.结论颈动脉体瘤的术前栓塞有助于减少术中出血,增加手术安全性,提高手术全切率和术后疗效.     

16层螺旋CT血管造影在脑膜瘤诊断中的应用价值

目的 探讨16层螺旋CT血管造影成像(MSCTA)在颅内脑膜瘤诊断中的临床应用价值. 资料与方法 回顾性分析35例脑膜瘤MSCTA检查资料.使用三维重组方法 包括:多平面重组(MPR)、表面遮盖成像技术(SSD)、最大强度投影(MIP)、容积再现技术(VRT). 结果 35例脑膜瘤MSCTA均获得颅骨、血管、肿瘤同时显示的三维立体图像.血管重组清晰显示脑膜瘤肿瘤染色及脑膜瘤与周围血管的关系.颅骨重组可显示脑膜瘤对邻近颅骨的影响. 结论 MSCTA可充分显示脑膜瘤的肿瘤、血管及其与邻近组织的关系,有助于脑膜瘤的诊断及治疗方案的制订,预测肿瘤切除的难易程度、手术风险、效果,指导手术方案的选择.     

颅内动脉瘤的介入治疗临床分析

目的 探讨破裂后颅内动脉瘤血管内弹簧圈栓塞治疗的临床价值.方法 对14例破裂后颅内动脉瘤施行血管内弹簧圈栓塞治疗,所有病例均经CT血管成像和DSA明确诊断.结果 14例患者栓塞成功12例,1例术中破裂,1例行手术夹闭.12例中随访到5例,1例术后3月出现大量头发脱落,1例术后头痛持续2月,5例在6～12月随诊脑血管造影,瘤体栓塞完全,载瘤动脉通畅.结论 血管内弹簧圈栓塞动脉瘤是防止动脉瘤再破裂出血的有效方法.     

320排CT三维血管成像技术在脑膜瘤术前评估中的应用

目的:探讨320排CT三维血管成像技在颅内脑膜瘤术前评估中的价值.方法:回顾性分析了经手术病理证实的36例颅内脑膜瘤患者的CT三维血管成像资料,所有患者术前均接受320排CT脑血管检查,并采用MPR、VR、MIP等三维后处理,观察及评估肿瘤与周围血管及静脉窦的关系,并与术中结果比较,分析CT血管成像术前诊断与术中所见是否一致.结果:36例CTA中34例均清楚显示脑膜瘤的供血血管,其中颈外动脉供血9例,颈外、颈内动脉共同供血8例,颈内动脉供血17例,2例供血动脉显示不清.CTA结果与术中所见比较,显示供血动脉率94.4％(34/36),准确判断符合率85.3％(29/34).CT静脉成像(CTV)示17例窦旁脑膜瘤中2例静脉窦正常,未受肿瘤侵犯,与术中所见一致,15例静脉窦不同程度受肿瘤侵犯,其中Ⅰ型5例,Ⅱ型7例,Ⅲ型3例,而术中示14例静脉窦受侵,1例未受侵,CTV与术前诊断符合率为94.1％(16/17);其余19例其他部位与静脉窦分界清晰,与术中所见一致.结论:320排CT血管成像术能清楚显示颅内脑膜瘤与邻近动脉、静脉的关系,对临床选择最佳手术入路、确定肿瘤切除范围和处理周围血管有重要的意义.     

双源CT静脉造影对上矢状窦旁脑膜瘤显微手术的价值探讨

目的 探讨脑双源CT静脉造影(CTV)显示上矢状窦旁脑膜瘤与上矢状窦关系、显示中央沟静脉和代偿回流静脉情况,从而为神经外科制定手术方案提供重要信息.方法 32例上矢状窦旁脑膜瘤患者行脑CTV检查,在工作站重建三维图像,术前判断肿瘤与静脉窦关系、显示中央沟静脉和代偿回流静脉并与术中情况对照.结果 根据CTV显示的窦腔狭窄程度,将上矢状窦旁脑膜瘤分为三型:Ⅰ型,瘤体与一侧静脉窦壁外层附着,静脉窦壁正常或轻度受压,窦腔通畅;Ⅱ型,肿瘤沿静脉窦壁生长,窦壁不规则增厚,窦腔变窄但尚通畅;Ⅲ型,瘤体长人静脉窦内或跨越生长,静脉窦腔内形成充盈缺损,窦腔闭塞,同时有静脉侧支循环建立.本组Ⅰ型8例,Ⅱ型15例,Ⅲ型9例.术中观察到代偿扩张的浅静脉以及肿瘤与中央沟静脉、上矢状窦的关系均与CTV结果相符.本组无术后严重神经功能受损和死亡病例.结论 上矢状窦旁脑膜瘤患者术前行CTV检查可以明确肿瘤部位、矢状窦阻塞程度及引流静脉代偿情况,为手术人路的选择及手术方案的制定提供重要信息,在全切肿瘤的同时减少并发症的发生,提高患者的生活质量.     

64层螺旋CT脑血管成像对颅内动脉瘤的临床诊断价值

目的:探讨64层螺旋CT脑血管成像(CTA)对颅内动脉瘤的临床诊断价值。方法:对55例临床怀疑颅内动脉瘤的蛛网膜下腔出血患者行64层螺旋CT脑血管成像检查,观察其原始图像及采用VR、MIP、MPR技术重建三维脑血管成像,部分病例同DSA或手术所见对照。结果:55名自发性蛛网膜下腔出血患者中,共检出动脉瘤患者47例,动脉硬化、狭窄3例,正常5例。CTA表现与手术结果、DSA基本一致。结论:64层螺旋CT脑血管成像能清晰的显示颅内动脉瘤的部位、大小、形态、瘤颈、与载瘤动脉及邻近血管及骨结构的关系,对颅内动脉瘤诊断敏感性及特异性较高,对绝大部分动脉瘤能迅速、准确地诊断,对临床治疗方案的制定有重要指导作用,并可作为术后复诊和随诊的重要手段。     

CT静脉造影对镰幕脑膜瘤手术方案的价值

目的 探讨脑CT静脉造影(CTV)对镰幕脑膜瘤手术方案的指导价值.方法 选取25例镰幕脑膜瘤患者术前行脑CTV检查,在工作站重建二维和三维图像,对脑膜瘤进行分型并判断邻近静脉的狭窄程度和代偿情况,据此选择能够安全避开主要回流静脉的手术入路.结果 根据镰幕脑膜瘤与邻近静脉(窦)关系及肿瘤生长方向,将镰幕脑膜瘤分为前、后、上、下和侧方5种类型.本组属前型者5例,后型4例,下型者3例,上型6例,侧方型7例.肿瘤与静脉(窦)的关系均与术中情况吻合,手术全切肿瘤19例,次全切除6例,主要的回流静脉均予保留.术后3例出现象限盲或偏盲,术后3个月随访时均完全恢复.结论 CTV可对镰幕脑膜瘤进行分型,有助于镰幕脑膜瘤手术入路的选择.     

Value of contrast-enhanced MR angiography and helical CT angiography in chronic thromboembolic pulmonary hypertension

The aim of this study was to evaluate the diagnostic value of contrast-enhanced MR angiography (ce MRA) and helical CT angiography (CTA) of the pulmonary arteries in the preoperative workup of patients with chronic thromboembolic pulmonary hypertension (CTEPH). The ce MRA and CTA studies of 32 patients were included in this retrospective evaluation. Image quality was scored by two independent blinded observers. Data sets were assessed for number of patent segmental, subsegmental arteries, and number of vascular segments with thrombotic wall thickening, intraluminal webs, and abnormal proximal to distal tapering. Image quality for MRA/CTA was scored excellent in 16 of 16, good in 11 of 14, moderate in 2 of 5, and poor in no examinations. The MRA/CTA showed 357 of 366 patent segmental and 627 of 834 patent subsegmental arteries. CTA was superior to MRA in visualization of thrombotic wall thickening (339 vs 164) and of intraluminal webs (257 vs 162). Abnormal proximal to distal tapering was better assessed by MRA than CTA (189 vs 16). In joint assessment of direct and indirect signs, MRA and CTA were equally effective (353 vs 355). MRA and CTA are equally effective in the detection of segmental occlusions of the pulmonary arteries in CTEPH. CTA is superior for the depiction of patent subsegmental arteries, of intraluminal webs, and for the direct demonstration of thrombotic wall thickening.     

MRA is useful as a follow-up technique after endovascular repair of aortic aneurysms with nitinol endoprostheses

PURPOSE: To evaluate whether MR angiography (MRA) is a useful tool for the follow-up of aortic aneurysms treated with nitinol endoluminal grafts. MATERIALS AND METHODS: We examined 28 patients treated with nitinol endovascular stents to repair an aortic aneurysm with CT angiography (CTA) and MRA. Eleven patients (group 1) underwent an MRA after a positive CTA for endoleak was observed. Afterwards, 17 patients (group 2) were scheduled for both follow-up examinations. The kind of endoleak that occurred and the maximum aortic diameter were compared. The sensitivity of CTA relative to MRA for detecting endoleaks in group 2 was calculated. Signal-to-noise ratios (SNRs) were measured in the aortoiliac lumen at the arterial phase in, above, and below the endoprostheses. Student's t-test was used to compare aneurysm dimensions and SNR measurements. RESULTS: Three type III leaks were correctly assessed at both examinations; however, CTA was less sensitive (50%) than MRA in depicting type II or unclassified leaks. No differences in aneurismal size were observed between the two examinations or between arterial SNRs observed in or out of the devices. CONCLUSION: MRA can provide all relevant information necessary for the follow-up of patients treated with nitinol endoprostheses, and performs better than CTA in detecting endoleaks.     

MR和CT血管造影在诊断颈动脉狭窄及内膜切除术后随访中的价值

目的 探讨磁共振血管造影（MRA）、CT血管造影（CTA）在诊断颈动脉狭窄及内膜切除术后随访中的价值。方法 11例22支颈动脉行MRA、CTA、CT仿真内窥镜（CTVE）、多普勒超声（DUS）检查。12支结果与DSA对照。3支颈动脉重度狭窄者行内膜切除术,MRA采用二维、三维时间飞越法。CTA经最大强度投影（MIP）及遮盖表现显示法（SSD）三维重建。应用导航功能行CTVE成像。结果 颈动脉轻度狭窄8支,中度狭窄3支,重度狭窄5支,闭塞1支,5支正常。12支颈动脉与DSA对照：CTA评估血管狭窄与DSA相符者11支,MRA与DSA相符者9支,DUS与DSA相符者7支。CTA、CTVE显示斑块、壁血栓6支,3支手术证实。术后MRA示狭窄解除,CTA示斑块消失。结论 MRA、DUS可用于颈动脉狭窄的筛选及术后随访。CTA评估血管狭窄程度与DSA、手术比较有较好的一致性,并能直接显示钙化斑块。     

MR angiography vs CT angiography in the follow-up of nitinol stent grafts in endoluminally treated aortic aneurysms

Our objective was to evaluate the accuracy of contrast-enhanced 3D MR angiography (MRA) in the follow-up of patients with endoluminally treated aortic aneurysms and correlate these findings with uni- or biphasic CT angiography (CTA). Forty MR angiograms in 32 patients with implanted aortic nitinol stent grafts were compared to CTA. Twenty-two MR examinations were correlated with arterial-phase CTA (uniphasic), and 18 MR examinations were correlated with biphasic CTA. Uniphasic CTA demonstrated three type-1/type-3 endoleaks and four reperfusion (type-2) endoleaks. In addition, MRA depicted two type-2 reperfusion endoleaks that were missed by CTA. Using biphasic CTA, two type-1/type-3 endoleaks and three reperfusion (type-2) endoleaks were detected; of those, delayed scanning detected three reperfusion (type-2) endoleaks missed during arterial-phase CTA. In addition to the findings by CTA, MRA depicted another type-2 reperfusion endoleak. Magnetic resonance angiography is at least as sensitive as uni- or biphasic CTA for detecting endoleaks and may consequently offer advantages in patients with contraindications to iodinated contrast agents.     

CT angiography and MR angiography in the evaluation of carotid cavernous sinus fistula prior to embolization: a comparison of techniques

BACKGROUND AND PURPOSE: This study compared CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA) in elucidating the size and location of carotid cavernous sinus fistulas (CCFs) before embolization treatment. METHODS: This was a retrospective study of 53 patients with angiographically confirmed CCF. All patients underwent pre- and postcontrast-enhanced CTA and DSA, and 50 patients also underwent MRA. Two neuroradiologists rated detectability of the fistula tract as "good," "moderate," or "poor" in source images obtained by using each procedure. The chi(2) test was used to compare the imaging modalities with respect to their ability to detect fistulas. RESULTS: CTA did not differ significantly from DSA (P = .155), and both CTA (P = .001) and DSA (P = .007) performed significantly better than MRA in the population as a whole. Differences in performance among the methods, however, depended upon the segmental location of the fistula along the internal carotid artery (ICA). CTA and MRA were similar in detection of CCFs in patients with a fistula at segment 3. CTA significantly outperformed MRA in patients with a fistula at segment 4, who accounted for approximately half of the population. CONCLUSIONS: CTA source imaging has proved itself as useful as DSA for detecting CCFs. Of the 2 noninvasive techniques, CTA performed better than MRA in the population as a whole and in most patients whose fistula was located at segment 4 or 5 of the ICA.     

The non-invasive detection of intracranial aneurysms: are neuroradiologists any better than other observers?

Can non-neuroradiologists detect intracranial aneurysms as well as neuroradiologists, using CT and MR angiography? Sixty patients undergoing intra-arterial digital subtraction angiography (IADSA) to detect aneurysms also underwent computed tomographic angiography (CTA) and time-of-flight magnetic resonance angiography (MRA). Consensus review of IADSA by two neuroradiologists was the reference standard. Two neuroradiologists, a neurosurgeon, a neuroradiographer and a general radiologist blinded to IADSA, plain CT and clinical data, independently reviewed hard-copy base and reconstructed maximum intensity projection images of the CTA and MRA studies. Thirty patients had a total of 63 aneurysms, 71.4% were 相似文献   

CT angiography in the evaluation of intracranial occlusive disease with collateral circulation: comparison with MR angiography

The purpose of this study is to determine whether three-dimensional computed tomography angiography (CTA) is superior to magnetic resonance angiography (MRA) in the evaluation of collateral circulation in patients with intracranial arterial occlusive disease. Conventional angiography was used as the standard reference. Collateral vessels were well visualized by CTA, but not by MRA, while conventional angiography revealed leptomeningeal collateral vessels that were filled in a retrograde fashion. CTA is superior to MRA for evaluating collateral vessels.     

颅内恶性脑膜瘤的诊断与治疗（附12例分析）

目的：探讨颅内恶性脑膜瘤的诊断与治疗。方法：12例恶性脑膜瘤患者术前均进行了CT和（或）MRI检查。全部行手术治疗,术后均由病理检查确诊。结合相关文献对其诊断和治疗进行讨论。结果：8例恶性脑膜瘤全切除,3例次全切除,1例大部切除。初次手术后即行放疗10例。术后7例因再次或多次复发,又行1～3次手术。复发者中术后放疗6例。结论：恶性脑膜瘤的临床表现和影像学特征与良性脑膜瘤相比无显著不同,术前诊断有一定难度,确诊需根据病理学检查。恶性脑膜瘤的治疗以手术切除为主,术后放疗可以延缓肿瘤复发。     

核素肺通气/灌注显像在肺动脉血栓栓塞症中的应用

目的 应用肺通气／灌注（V／Q）显像研究下肢深静脉血栓（DVT）患者肺栓塞（PE）发病情况，并与CT血管造影（CTA）或MR血管造影（MRA）结果进行比较。方法 85例DVT患者进行肺通气（Technegas）／^99Tc^m-聚合白蛋白（MAA）灌注显像和X线胸片检查，其中13例同期进行肺CTA或MRA检查。根据PIOPED诊断标准（1995年修正版），综合分析肺V／Q显像和X线胸片结果，划分为PE高、中、低、极低度可能性和正常5类，并以低、中和高度PE可能性者为阳性，极低可能性和正常者为阴性。结果 85例患者中，PE高度可能性34.1％，中度可能性8．2％，低度可能性7．1％，极低度可能性1．2％，正常49．4％，共计阳性率49．4％，阴性率50．6％。13例同期进行CTA或MRA检查的患者中，3例V／Q显像和CTA或MRA发现病灶数量和范围一致，10例不一致。肺动脉部分栓塞时，由于血流可通过，肺组织灌注可能正常，V／Q显像往往不能发现病变血管。而外周肺段、亚分段较小肺动脉栓塞时，CTA或MRA容易漏诊。结论 V／Q显像可以提供优良、准确的PE诊断结果，CTA检查与其可优势互补。     

多层螺旋CT和三维屏气MR冠状动脉成像的对比研究

目的比较16层螺旋CT（16 multi-detector CT,16-MDCT）冠状动脉血管造影（CTA）和三维屏气冠状动脉MR血管造影（MRA）的图像质量以及诊断冠状动脉显著性狭窄（＞50%）的准确性.方法40例疑有冠心病患者在3 d内均行冠状动脉CTA和MRA检查,其中31例患者在2周内行冠状动脉造影检查.将冠状动脉分成9个节段（右冠状动脉近、中、远段,左冠状动脉主干,前降支近、中、远段和旋支近、远段）,由2名影像科医生共同对各个节段的图像质量按0～4级评分,比较CTA和MRA上各个节段的图像质量.以冠状动脉造影为标准,计算并比较CTA和MRA诊断31例冠状动脉显著性狭窄（＞50%）各项准确性指标.结果CTA在右冠状动脉中段的图像质量低于MRA,右冠状动脉近段二者无区别,其他节段均优于MRA.冠状动脉造影显示31例患者共有43个节段狭窄＞50%,CTA和MRA分别正确诊断出36和27个,其敏感性、特异性、阳性预测值和阴性预测值分别为83%、84%、49%、97%和63%、90%、55%、93%.结论除右冠状动脉中段,CTA大部分节段的图像质量优于MRA.CTA诊断冠状动脉显著性狭窄的敏感性高于MRA,但特异性低于MRA.冠状动脉CTA和MRA均表现了较高的阴性预测值,对排除冠状动脉狭窄具有临床价值.