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3D-CTA、DSA对颅内动脉瘤诊疗价值的对比
引用本文:李祥,于如同,范月超,郭克勤.3D-CTA、DSA对颅内动脉瘤诊疗价值的对比[J].中华神经外科杂志,2009,25(2).
作者姓名:李祥  于如同  范月超  郭克勤
作者单位:徐州医学院附属医院神经外科,221000
基金项目:江苏省医学领军人才基金,江苏省卫生厅课题 
摘    要:目的 评价3D-DSA、3D-CTA、2D-DSA在颅内动脉瘤诊疗中的作用.方法 回顾性分析32例动脉瘤患者3D-DSA、3D-CTA、2D-DSA和手术资料.结果 32例患者共35个动脉瘤(有3例患者为多发动脉瘤).3D-DSA能清楚显示所有动脉瘤的形态,准确判断3例多发动脉瘤中破裂的动脉瘤且手术顺利夹闭;3D-CTA检出33个,遗漏1个前交通动脉瘤及1个颈内动脉瘤;2D-DSA检出32个,遗漏2个前交通动脉瘤和1个大脑中动脉瘤.3D-DSA及3D-CTA在显示瘤颈上明显优于2D-DSA,3D-CTA可准确显示动脉瘤与相邻骨质结构关系.结论 3D~CTA是检查颅内动脉瘤高度敏感的无创影像手段,其诊断效价优于2D-DSA,可以作为动脉瘤首选影像学诊断方法 .必要时再行3D-DSA进行确诊,尤其是多发复杂动脉瘤和微小动脉瘤及3D-CTA阴性的SAH患者,3D-DSA应视作颅内动脉瘤诊断的金标准.

关 键 词:颅内动脉瘤  数字减影血管造影  CT血管成像  显微外科手术

Comparative study of 3D-CTA and DSA in the diagnosis and treatment of intracranial aneurysms
LI Xiang,YU Ru-tong,FAN Yue-chao,GUO Ke-qin.Comparative study of 3D-CTA and DSA in the diagnosis and treatment of intracranial aneurysms[J].Chinese Journal of Neurosurgery,2009,25(2).
Authors:LI Xiang  YU Ru-tong  FAN Yue-chao  GUO Ke-qin
Abstract:Objective To compare the clinical value of three-dimensional digital subtraction angiography(3D-DSA), three-dimensional computed tomographic angiography (3D-CTA) and conventional DSA(2D-DSA) in the diagnosis and treatment of Intracranial aneurysms. Methods The data of 3D-DSA, 3D-CTA, 2D-DSA and operation of 32 patients with Intracranial aneurysms were reviewed, retrospectively. Results 35 aneurysms were detected by 3D-DSA and correlated well with microsurgical findings. The shape of the aneurysms, their neck size and their relationships to the parent vessels and other branches were depicted clearly, especially compared with images obtained by 3D-CTA and 2D-DSA. 33 aneurysms were detected by 3D-CTA. 32 aneurysms were detected by 2D-DSA. Aneurysms' body, neck, parent artery and the relationship between the aneurysms and surrounding structures (bone) were clearly and surely displayed by 3D-CTA. Conclusion 3D-CTA is a sensitivity and rapid and noninvasive method for detecting aneurysms. 3D-CTA can be the first choice for diagnosing Intracranial aneurysms without performing 2D-DSA. During CT for ruptured aneurysms, a negative 3D-CTA should be investigated further by 3D-DSA. 3D-DSA should be performed in cases of multiple intracranial aneurysms with complex shapes or very small size. 3D-DSA should be the "gold standard" for detecting intracranial aneurysms.
Keywords:Intracranial aneurysms  Digital subtraction angiography  Computed tomographic angiography  Microsurgery
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