三维数字血管造影在颅内动脉瘤诊治中的应用

目的探讨三维数字血管造影(3D-RA)对颅内动脉瘤诊治的应用价值及其与常规DSA检查相比的优势。方法回顾资料完整的38例40枚颅内动脉瘤患者。分析全脑血管常规DSA造影及病变血管或病变疑似血管3D-RA检查和三维重建图像。分别观察记录常规DSA及3D-RA对颅内动脉瘤提供的诊断信息。24例采用手术开颅银夹夹闭动脉瘤治疗,14例采用血管内栓塞治疗。结果38例40枚颅内动脉瘤,其中前交通动脉瘤16枚,后交通动脉瘤13枚,大脑中动脉分叉部动脉瘤5枚,颈内动脉瘤3枚,椎基底动脉瘤2枚,小脑后下动脉瘤1枚;其中小型动脉瘤(动脉瘤体直径小于5mm)12枚,中型动脉瘤(动脉瘤体直径6~10mm)20枚,大型动脉瘤(动脉瘤体直径16~25mm)6枚,巨型动脉瘤(动脉瘤体直径大于25mm)2枚;动脉瘤呈囊袋状23枚,呈哑铃形12枚,不规则形4枚,梭形1枚;颅内动脉瘤单发36例,多发2例。常规DSA诊断动脉瘤37枚,占92.5%(37/40),3D-RA诊断动脉瘤40枚,占100%(40/40)。经与手术或血管内栓塞治疗结果比较,本组DSA诊断颅内动脉瘤敏感性92.5%,特异性100%,准确率96%。3D-RA诊断颅内动脉瘤敏感性及特异性均为100%,准确率100%。结论3D-RA能较常规DSA更好的显示颅内动脉瘤的形态、大小、瘤颈部及载瘤动脉与动脉瘤的关系、动脉瘤囊腔有无重要分支发出等等。

Three-dimensional rotational angiography in diagnosis and treatment of intracranial aneurysm

Objective To explore the value of three-dimensional rotational angiography (3D-RA) compared with routine DSA examination in diagnosis and treatment of intracranial aneurysms. Methods The imaging materials of routine DSA and 3D-RA of 38 patients with 40 aneurysms were reviewed. The abnormal vessels or suspected ones were performed angiography with oblique view as well as 3D-RA and then reconstructed. The information for aneurysms by routine DSA and 3D-RA were observed. 24 patients got surgery operation and 14 patients were cured by endovascular embolization. Results Forty intracranial aneurysms were diagnosed in 38 patients: 16 on anterior communication arteries, 13 on posterior communication arteries, 5 on bifurcation of middle cerebral arteries, 3 on internal carotid arteries, 2 on vertebrobasilar arteries, and 1 on inferior posterior cerebellar artery; 12 in small size (<5 mm), 20 in middle size (6-10 mm), 6 in big size (16-25 mm), and 2 were giant (>25 mm); 23 as cyst type, 12 as dumbbell, 4 irregular shape, and 1 as fusiform. 36 cases were with single lesion, 2 with multiple. According with the results of surgery or endovascular embolization, the sensitivity, specificity and accuracy with routine-DSA were 92.5%, 100% and 96% respectively; the values with 3D-RA were all 100%. Conclusion 3D-RA can take better play in diagnosis and treatment of intracranial aneurysm than that of routine DSA in shape, size, the relationship between aneurysm and feeding arteries and embranchment from aneurysm.