三维CT血管造影在脑动静脉畸形诊治中的初步应用经验

目的 评估三维CT血管造影（3D－CTA）在脑动静脉畸形诊断及术前评估中的应用。方法 对我科收治的25例脑动静脉畸形患者采用3D－CTA检查，并同期行脑数字减影血管造影（DSA），比较两种检查的结果。结果 3D－CAT显示了24例动静脉畸形，3D－CTA在显示畸形血管闭、供血动脉和引流静脉的三维构造以及空间关系上优于DSA，并能显示三者与颅骨的关系。3D－CTA虽未能发现1例小型小脑动静脉畸形，但其显示了一个位于小脑后下动脉（PICA）远端的供血动脉动脉瘤，并确定了出血系动脉瘤而非动静脉畸形。3D－CTA可以模拟手术入路时可观察到的血管构造，有助于正确判断动静脉畸形的各种成分，提高手术的安全性。结论 3D－CTA对脑动静脉畸形的诊断及其术前评估有其独特的价值。尤其适合于大型脑动静脉畸形、动静脉畸形合并动脉瘤以及颅内巨大血肿怀疑系动静脉畸形破裂者。它与DSA可互补，但尚无法取代DSA。

Preliminary experience of three-dimensional computed tomography angiography (3D-CTA) in the diagnosis and preoperative evaluation of cerebral arteriovenous malformations(AVMs)

Objective To assess the role of 3D CTA in the diagnosis and preoperative evaluation of cerebral AVMs.Methods Twenty five consecutive cases of cerebral AVM were studied with both 3D CTA and digital subtraction angiography (DSA). 3D CTA images were reconstructed by surface shaded display(SSD), maximum intensity projection (MIP), color SSD and transparent SSD methods. Results 3D CTA images demonstrated 24 AVMs whereas DSA showed 25 AVMs. 3D CTA is superior to DSA for depicting the 3D angioarchitecture of the feeding arteries, nidus and draining veins as well as surrounding bony structures. In a patient with small cerebellar AVM associated one aneurysm of feeding artery, 3D CTA did not reveal the small AVM but clearly revealed the coexisting aneurysm of distal posterior inferior cerebellar artery (PICA) which can not demonstrated clearly by DSA. 3D CTA reconstruction in an operative view were useful in identification of feeding arteries, nidus and draining veins during the operation. Conclusions 3D CTA has its own unique features not present in DSA. It is suitable for large AVMs, AVM associated aneurysm and giant intracranial hematoma highly suspicion of AVM bleeding. However, 3D CTA can not replace DSA. DSA is still the golden standard for evaluation of AVMs.