多排三维螺旋CT血管造影在脑膜瘤手术前评估中的应用

目的评估多排三维CT血管造影(3D-CTA)对脑膜瘤手术治疗的指导价值。方法对48例CT、MRI临床证实为脑膜瘤患者术前行3D-CTA检查,其中病变位于矢状窦镰旁17例、蝶骨嵴12例、嗅沟7例、小脑幕6例、鞍结节4例、桥小脑角2例。CTA图像采用遮盖容积重建(SVR)、最大密度投影(MIP)和彩色表面阴影显示法(SSD)3种处理技术。对三维图像进行旋转、切割及相关测量,模拟最佳手术入路,对其影像学特点与手术中所见进行对比研究。结果3D-CTA能清楚显示脑膜瘤的形态及其与邻近大血管、颅骨的三维关系和静脉窦的开放程度,为术中正确处理静脉窦提供可靠的信息。可以模拟手术入路时观察到的血管,为手术前选择手术入路提供了重要信息,提高手术的安全性。结论3D-CTA提供了脑膜瘤与邻近血管和颅骨的三维空间图像,可清晰显示脑膜瘤与周围大血管关系,可以从多角度模拟手术路径,选择最佳手术入路,在脑膜瘤术前评估中有其独特的价值。

The clinical value of multi-slice three-dimensional computed tomographic angiography in preoperation of meningioma

Objective To evaluate the clinical value of multi-slice three-dimensional computed tomographic angiography(3D-CTA)in the preoperation of meningiomas.Methods 48 cases with meningiomas confirmed by CT and MRI were examined with the 3D-CTA from December 2001 to December 2004.Tumors were located in parasaittal and falcine for 17 cases,12 cases in sphenoidal,7 cases in olfactory groove,6 cases in tentorial,4 cases in parasellar,2 cases in the cerebellopontine angle.The reconstructed images were processed into shaded volume rendering(SVR)and maximal intensity projection (MIP)and color shaded surface display(SSD).3D-images were applied to imitate the approach of operation.Surgery was performed according to the images of 3D-CTA.Results 3D-CTA provided the clear three dimensional images of the meningioma and the relationship with the adjacent vessels and the skull base.It demonstrated the proper surgical approach to remove the neoplasm.The results of 3D-CTA corresponded very well to the surgery.Conclusions 3D-CTA can provide 3D images of the meningioma, adjacent vessels and the bones in the skull base.It can supply the vital information to choose the proper surgical approach and provide the useful message to management the sinus during the operation.It has a great value in preoperative evaluation of the meningioma.