MSCT 3D-CTA在颅内动脉瘤夹闭术后复查评价中的应用

目的探讨多层螺旋CT血管成像（MSCT 3D-CTA）在颅内动脉瘤夹闭术后复查评价的应用意义。方法回顾性分析48例实施颅内动脉瘤夹闭术患者的术前、后MSCT 3D-CTA资料。采用16排螺旋CT扫描,用最大密度投影（MIP）、容积重建（VR）和多平面重建（MPR）技术对原始采集数据进行后处理。结果复查的48例患者中,发现动脉瘤夹48个,其中,前交通动脉瘤15例,后交通动脉瘤18例,大脑中动脉瘤15例。MSCT3D-CTA发现动脉瘤残留6例,载瘤动脉局限性狭窄12例,伴有血管痉挛9例,未见明显异常21例。所有病例未见载瘤动脉闭塞及动脉瘤夹滑脱、移位。VR成像中,36例清晰显示动脉瘤夹与载瘤动脉的三维空间关系,9例较清晰显示,3例动脉瘤近胼周者显示欠佳;在MIP和MPR成像中,动脉瘤夹形态及大小均能清晰显示,但三维空间感较VR略差。结论 MSCT 3D-CTA是颅内动脉瘤夹闭术后经济、安全、有效的复查方法,VR和MIP、MPR等后处理技术的联合运用可以更好地显示颅内动脉瘤夹闭术后的改变。

Application of MSCT-3D CTA in evaluating of the intracranial aneurysm clip operation

Objective Evaluate Multi-Slice Three-Dimensional CT Angiography for the follow-up of intracranial aneurysm clipping. Methods Retrospectively analyzed 48 patients with intracranial aneurysm clipping via MS 3D-CTA.All patients were scanned on 16-Slice spiral CT（GE Lightspeed Pro）.All cases employed Thin MIP（Thin maximum intensity projection）、VR（Volume rendering） and MPR（Multi-Planar reconstruction） in the image post processing. Results There were 48 clips in the 48 patients with aneurysm clipping. 15 clips located at the anterior communicating artery, 18 clips located at the posterior communicating artery, 15 clips located at the middle cerebral artery. By the check of the MS 3D-CTA, there were residual aneurysm in 6 patients,parent artery stneosis in 12 patients, artery spasm in 9 patients, and remain 21 patients without any abnormalities found in the aneurysm clipping region. There was no parent artery occlusion and clip displacement in all the 48 patients. 36 patients were showed excellent 3D relationship between the clip and parent artery by the VR imaging. 9 patients showed good relation.3 clips near the pericallosal artery showed not good enough. The thin MIP and MPR can depicted the size and shape of the aneurysm clips. But the 3D relation of the aneurysm clip and the parent artery showed not as good as VR. Conclusion MS 3D-CTA is a economical、safe and efficient method for the follow-up of intranialaneurysm clipping. if combined the VR and thin MIP、MPR can well reveal the postoperative changes after the aneurysm clipping.