三维CT血管造影在颅内动脉瘤诊断及术后评价的意义

目的探讨三维CT血管造影（3D—CTA）对颅内动脉瘤的诊断价值,以及对动脉瘤夹闭术后评价其指导价值。方法回顾性分析32例临床怀疑为颅内动脉瘤,并进行了CT血管造影（CTA）和数字减影血管造影（DSA）检查的患者,以DSA和手术作为参考标准,评价3D-CTA诊断价值。对其中的5例动脉瘤夹闭病例进行术后评价,术前术后均进行了CTA检查,通过比较两次CTA结果评价动脉瘤夹闭情况。结果根据DSA资料及手术结果,CTA发现颅内动脉瘤的敏感性为100％,特异性为100％,准确性为93．9％。对5例动脉瘤钛夹夹闭术后的患者通过CTA进行了随访,与术前CTA相比,颅内大血管均未见狭窄或闭塞。结论3D—CTA诊断颅内动脉瘤具有较好的特异性和敏感性,以及较好的三维显示能力,是一种可靠、微创的快速诊断颅内动脉瘤的方法,为手术提供了详实的影像学资料,并有助于制定治疗方案。

Application of 3D-CT angiography in the diagnosis and post-operative evaluation of intracranial aneurysms

OBJECTIVE: To assess the values of three-dimensional CT (3D-CT) angiography (3D-CTA) in the diagnosis and operative follow up of intracranial aneurysms after clip. METHODS: 3D-CTA and DSA were performed on 32 patients with clinical manifestations suggestive of harboring intracranial aneurysms. DSA and operation were regarded as gold standards. Five patients who had been treated with clip underwent CTA both preoperatively and postoperatively to evaluate the effects of aneurysm clipping. RESULTS: According to DSA results and surgical findings, the sensitivity, specificity, and the accuracy of 3D-CTA for the detection of aneurysms were 100%, 100%, and 93.9% respectively. The detection rate of aneurysm with a diameter<3 mm of CTA, with the smallest diameter of 2 mm, was higher than that of DSA, however, there was no significant difference in the detection rate of aneurysm with the diameter>3 mm between CTA and DSA. Postoperative CTA displayed a remnant of aneurysm body in one case. CONCLUSION: With satisfying sensitivity and specificity, 3D-CTA is a quick, reliable, and relatively noninvasive diagnostic tool for intracranial aneurysms. 3D-CTA combined with VR delineates the aneurysmal morphology in detail, and provides useful information for choosing and planning microsurgical or endovascular treatment.