三维CT血管造影对颅内动脉瘤夹闭术后的评价意义

目的 探索颅内动脉瘤夹闭术后方便、安全、可靠的评价方法 ,研究三维CT血管造影(3D-CTA)对术后评价的临床意义. 方法 回顾性分析我院自2006年1月至2007年3月收治颅内动脉瘤患者120例,显微手术夹闭52例,术后采用3D-CTA随访手术患者20例,其中多发动脉瘤1例,动脉瘤数21个(前交通动脉瘤11个,后交通动脉瘤7个,大脑中动脉M3段1个,脉络膜前动脉1个,大脑前动脉A1段起始部1个),随访2～38周,平均(15±11)周,观察术后瘤夹位置,载瘤动脉近段与远段通畅情况,瘤体及瘤颈残留等. 结果 3D-CTA显示动脉瘤夹位置良好19例,瘤央冈合并弹簧圈放射状伪影难以准确显示1例:载瘤动脉近段及远段通畅良好20例,可清楚分辨出瘤夹与载瘤动脉之间关系,未发现动脉瘤体残留. 结论 3D-CTA可作为动脉瘤夹闭术后随访评价的重要方法 ,具有重要的临床应用价值.

Value of three-dimensional CT angiography in postoperative evaluation of intracranial aneurysm clipping

Objective To assess the value of three-dimensional multislice CT angiography (CTA) in evaluating the therapeutic effect of intracranial aneurysm clipping and explore a convenient, safe and reliable method for the postoperative evaluation. Methods Of the 120 patients with intracranial aneurysms hospitalized from January, 2006 to March, 2007 in our hospital, 52 patients were treated with aneurysm clipping using titanium clips. Follow-up study for 2-38 weeks (mean 15±11weeks) was conducted in 20 of the patients with 21 aneurysms (1 patient had multiple aneurysms), including 1 in the anterior cerebral communicating artery, 7 in the posterior cerebral communicating arteries, 2 in the M3 segment of the middle cerebral arteries, 1 in the anterior choroidal artery, and 1 near the AI segment. Three-dimensional multislice CTA was performed in these patients, and the location of clips, patency of the proximal and distal segments of the parent arteries, presence of the remnant necks and domes of the aneurysms were evaluated with maximum intensity projection (MIP) and volume rendering (VR). Results The locations of 20 aneurysm clips were well visualized, and one clip was not clearly shown due to the artifacts of the clip and coils. All the proximal and distal segments of the parent arteries were clearly visualized and the relationship between the clips and the aneurysms was well demonstrated by MIP and VR in CTA. No remnant domes of the clipped aneurysms were found in these patients. Conclusion Three-dimensional multislice CTA provides an important means for postoperative evaluation of intracranial aneurysms treated with titanium clips and have great value in clinical practice.