640层3D-CTA在颅内动脉瘤诊疗中的应用

目的：通过3D-CTA与3D-DSA的对比,评价3D-CTA在颅内动脉瘤诊治中的价值。方法本院神经外科2012年8月至2013年8月收治53例疑为颅内动脉瘤患者,均行3D-CTA与3D-DSA检查,确诊为动脉瘤后行开颅手术夹闭或血管内介入栓塞。比较3D-CTA与3D-DSA对动脉瘤诊断的价值。结果3D-DSA准确检出所有动脉瘤57个,3D-CTA准确检出56个,遗漏1个,两者的检出准确率无明显差异（P〉0.05）。将3D-CTA与3D-DSA影像上所测得的瘤颈、瘤体直径比较,检查结果差异均无明显统计学意义（P〉0.05）。结论640层3D-CTA具有无创、经济、便捷的优点,诊断颅内动脉瘤有较高的准确率,一定程度上可以替代DSA,部分动脉瘤可以只凭3D-CTA指导手术。     

示踪减影透视在颅内动脉瘤介入治疗中的临床应用

目的探讨示踪减影透视(TSF)在颅内动脉瘤介入治疗中的临床应用价值。方法 11例接受介入栓塞治疗的颅内动脉瘤患者,术前均接受双源CT血管成像(DSCTA)及全脑数字减影血管造影(DSA)检查,确定动脉瘤的大小、形态、位置,并测量瘤颈及瘤体的直径;术中应用TSF技术。结果 11例患者(共11个动脉瘤)介入栓塞均获得成功,共植入电解可脱弹簧圈39枚,包括1枚3-D标准成篮填充弹簧圈,3枚3-D软成篮填充弹簧圈及35枚柔软型填充弹簧圈。结论对接受颅内动脉瘤介入栓塞治疗的患者,术中应用TSF可提高治疗效果。     

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。     

3D-CTA在破裂动脉瘤诊断及指导治疗中的价值

目的:探讨3D计算机断层血管造影术(3D-CTA)在破裂脑动脉瘤诊治中的临床应用价值。方法:选取2012年9月—2017年6月采用介入手术治疗的47例颅内动脉瘤破裂出血患者作为研究对象,所有患者在手术前均接受了3D-CTA检查、数字剪影血管造影(DSA)检查,以DSA检查结果作为金标准,计算3D-CTA诊断颅内动脉瘤的符合率;并对47例患者的介入栓塞治疗效果进行临床评价。结果:47例颅内动脉瘤破裂出血患者,经DSA检查共发现51处动脉瘤,其中破裂出血47个,4个未破裂;3D-CTA检查共计发现动脉瘤48个,其中对大脑中动脉瘤、小脑后下动脉动脉瘤、脉络膜前动脉瘤、A1～A3段动脉瘤、椎动脉动脉瘤的检出率与DSA检查结果的符合率均达到100%;漏诊前交通动脉瘤、后交通动脉瘤、床突段动脉瘤各1个,与DSA检查结果的诊断符合率分别为94.74%、93.33%、66.67%;3D-CTA诊断动脉瘤的结果与DSA的结果整体符合率为94.12%;47例患者均成功实施手术,术后进行动脉瘤栓塞效果评价,其中达到0级标准43个、达到1级标准8个;出现脑梗死2例,术中破裂出血2例;术后28 d及术后3个月两组患者的mRS分级情况良好,术后28 d及术后3个月的预后良好率分别为72.34%、85.11%。结论:3D-CTA在破裂脑动脉瘤诊断中与DSA具有极高的符合率,因其具有检测时间短、无创等优势,在临床指导动脉瘤诊断及介入治疗中具有重要价值。     

脑血管造影三维重建成像在脑动脉瘤诊断和治疗中的初步应用

目的 总结脑血管造影三维重建成像在脑动脉瘤诊断和治疗中的初步应用经验,以提高诊断水平和治疗效果。方法 对65例确诊或疑诊为脑动脉瘤的病例分别行常规脑血管造影成像（二维影像）和脑血管造影三维重建成像（三维影像）检查,并对其结果进行对比分析。结果 65例患者经上述检查,共检出60例66个动脉瘤,5例造影阴性。60例6个动脉瘤中,囊内栓塞43例46个;行载瘤动脉闭塞3例3个;外科手术10例10个;颅内外动脉搭桥术后闭塞载瘤动脉1例1个;未治疗3例6个。有2个动脉瘤二维影像上未显示,而三维影像上显示;3个动脉瘤通过二维影像认为不适合栓塞十分困难或危险,通过三维影像的帮助得以栓塞;3个动脉瘤二维影像上显示可行栓塞,而三维影像发现不能栓塞。囊内栓塞的46个动脉瘤中,38个（82.6%)二维影像上达100%栓塞,但其中8个三维影像上有残留。结论 脑血管造影三维重建成像可提高颅内动脉瘤诊断的准确性和治疗的安全性。     

颅内后循环动脉瘤的血管内介入治疗

目的总结颅内后循环动脉瘤的特点,探讨其血管内介入治疗的临床疗效。方法回顾性分析40例行血管内介入治疗的颅内后循环动脉瘤患者的临床和影像学资料、介入治疗过程,观察期效果及术后随访结果。结果 40例患者共发现42个后循环动脉瘤,均完成血管内介入治疗,其中8个行单纯弹簧圈栓塞,28个行支架辅助栓塞,1个行Onyx胶栓塞,5个动脉瘤及载瘤动脉同时闭塞。术后即刻DSA造影显示动脉瘤完全栓塞30个,近全栓塞6个,部分栓塞6个。术后6个月随访DSA造影显示动脉瘤完全栓塞36个,近全栓塞4个,部分栓塞1个。患者出院时行改良Rankin量表(mRS)评分,0分35例,1分3例,2分1例,1例死亡为6分;出院后3~6个月随访mRS评分0分38例,1分1例,无动脉瘤复发及新发神经功能障碍病例。结论颅内后循环动脉瘤具有特殊的临床与影像学表现,且复杂动脉瘤较为常见,对于颅内后循环动脉瘤,血管内介入治疗是一种安全有效的治疗方法。     

Hunt-HessⅣ级颅内动脉瘤的早期血管内治疗

目的 探讨早期血管内栓塞颅内Hunt-Hess分级Ⅳ级动脉瘤的临床疗效及应用价值。方法 回顾性分析早期血管内栓塞治疗颅内动脉瘤16例16个颅内动脉瘤。结果 16例完全栓塞11例，大部分栓塞5例，1例死亡，并发动脉瘤破裂2例、脑血管痉挛3例、脑梗死2例、4例再次栓塞后痊愈。结论 早期血管内栓塞是治疗颅内Hunt-Hess分级Ⅳ级动脉瘤较理想方法。     

旋转DSA三维重建成像对观察血管空间解剖关系的价值

目的探讨旋转DSA三维重建数字减影血管成像（3DDSA）对观察血管空间解剖关系的价值。方法69例患者同时进行了常规DSA和3DDSA检查。常规DSA后进行旋转DSA检查,对旋转DSA采集的数据进行容积三维重建。由2位工作经验丰富的阅片者采用双盲法对2DDSA和3DDSA的图像进行分析。结果69例患者中,常规DSA诊断阳性病例65例（阳性率94．20％）,3DDSA诊断阳性病例62例（阳性率为89．86％）。在常规DSA和3DDSA中,分别有44例（67．69％）阳性病例和62例（100％）阳性病例病变周围血管关系显示清晰满意。结论3DDSA能更清晰地显示病变血管及其与相邻血管间的关系,尤其对血管性病变具有重要价值,是对常规血管造影的重要补充。     

2D DSA、3D DSA与CTA对颅内动脉瘤诊断的比较研究

目的比较评价2D DSA、3D DSA(MIP、SSD、VR)及CTA(SVR)几种方法对颅内动脉瘤诊断的价值。方法对34例蛛网膜下腔出血的患者经常规DSA、3D DSA及CTA检查诊断颅内动脉瘤28例,检出动脉瘤33个。回顾性分析对比2D DSA、3D DSA及CTA几种方法对33个动脉瘤的显示情况,分别对动脉瘤的检出率和动脉瘤颈的可见度及与载瘤血管位置关系进行评价。结果就动脉瘤检出情况,2D DSA与CTA间无明显统计学差异,3D DSA的SSD、VR与CTA间有明显统计学差异。对于瘤颈及与载瘤血管的关系的显示,2D DSA与CTA间存在显著性差异。3D DSA的SSD、VR与CTA间存在显著性差异。结论2D DSA与CTA在动脉瘤的检出率方面无显著差异,但在瘤形态、瘤颈及与载瘤血管的关系方面,CTA优于2D DSA。3D DSA在瘤的检出率、瘤颈及与载瘤血管的显示方面均较CTA有明显优势。     

三维数字减影血管造影血管虚拟内镜成像在颅内动脉瘤诊治中的作用

目的探讨三维数字减影血管造影（three dimensional digital subtraction angiography,3D DSA）血管虚拟内镜成像在颅内动脉瘤诊治中的作用。方法回顾性分析53例颅内动脉瘤三维DSA血管虚拟内镜成像资料并应用三维DSA血管虚拟内镜成像随访术后载瘤血管及瘤颈残留情况。三维的旋转数字图像由脑血管造影机球管和影像增强器的同步2次240°旋转获得,应用Volume Viewer软件对原始三维图像进行重建,固定密度值并选取感兴趣区,用Navigator软件进行血管虚拟内镜成像,观察血管腔内结构。结果 53例术前三维DSA血管虚拟内镜成像清晰,共检出动脉瘤62个,其中动脉瘤体有穿支血管发出19例（15例手术证实）,动脉瘤内有血栓形成7例（4例手术证实）,载瘤动脉内有动脉粥样硬化斑块5例（3例手术证实）。术后31例3D DSA随访：28例未见瘤颈残留,2例出现载瘤动脉轻度狭窄;2例弹簧圈突入载瘤动脉血管腔内;1例动脉瘤栓塞后瘤颈复发残留,再次开颅夹闭动脉瘤。结论三维DSA血管虚拟内镜成像是一种安全有效的评估颅内动脉瘤管腔结构的方法,不仅可以用于动脉瘤的术前判断,指导手术方式的选择,也可以用于动脉瘤术后的随访,为明确术后载瘤动脉及瘤颈情况提供依据。     

Evaluation of a distal pericallosal aneurysm visualized with 3-dimensional digital subtraction angiography: case report and treatment implications

BACKGROUND: Digital subtraction angiography (DSA) is considered the gold standard in the evaluation of cerebrovascular structures. Recently, 3-dimensional DSA (3D-DSA) has been increasingly used to obtain detailed information about the morphology and dimensions of intracranial aneurysms. We report the case of a patient who presented with a distal pericallosal artery aneurysm, which appeared by 2D imaging to be a fusiform, possible mycotic aneurysm. This was then revealed to be a saccular bifurcation aneurysm by 3D-DSA. This additional information changed the treatment plan for this patient from medical management to a surgical approach. CASE DESCRIPTION: The patient is a 56-year-old man with a history of hypertension and alcohol abuse with withdrawal seizures, who presented with a large intracranial hemorrhage on initial computed tomography scan. After stabilization with intracranial pressure management, the patient underwent magnetic resonance angiography and 4-vessel DSA. These initial studies showed a distal, fusiform pericallosal aneurysm consistent with a mycotic aneurysm. Rotational DSA was then used to generate 3D images of the structure that revealed a saccular bifurcation aneurysm. This enabled the decision to offer operative treatment rather than conservative medical management. DISCUSSION: This report highlights the value of 3D-DSA in establishing the appropriate treatment plan for patients with unique cerebral aneurysms. The higher resolution images used in this case provided information that was crucial in shifting the treatment focus from medical management, for what appeared to be a mycotic aneurysm by traditional DSA, to surgical intervention, for a clear hemodynamic aneurysm at a vessel bifurcation seen with 3D-DSA. Accurate pre-interventional evaluation and differential diagnosis are critical to designing the most effective lowest risk treatment plan. The standard method in the diagnosis of cerebral aneurysms has been DSA. Yet, higher resolution images of unclear or high-risk aneurysms are often required to guide clinical decision making. The emergence of new, less invasive endovascular techniques for securing intracranial aneurysms has placed greater emphasis on precisely defining the shape and dimensions of an aneurysm. Three-dimensional DSA is currently the highest resolution imaging modality available for the evaluation of intracranial aneurysms. CONCLUSION: 3D-DSA was used to evaluate a small, distal pericallosal artery aneurysm and revealed a saccular bifurcation aneurysm not visualized with magnetic resonance angiography and conventional DSA. This additional resolution permitted the team to consider a surgical approach for a patient who would otherwise have been treated medically. This high-resolution technique is particularly useful in guiding clinical decision making in the context of aneurysms that carry a relatively broad differential diagnosis, potentially high interventional risk, and unclear morphology.     

大脑中动脉巨大型动脉瘤的手术治疗

目的 探讨大脑中动脉巨大型动脉瘤的手术治疗方法.方法 回顾性分析2001年1月至2008年3月17例颅内大脑中动脉巨大型动脉瘤患者的手术方法和疗效.术前采用CT、CTA、MR、MRA、DSA及三维DSA检查,以了解动脉瘤的部位、大小,形状以及侧支代偿情况,制定个体化治疗方案.在手术入路上多采用改良翼点入路,其中行动脉瘤瘤颈直接或塑形夹闭者4例,动脉瘤孤立或孤立后切除4例,动脉瘤切除或孤立后血管重建7例,动脉瘤包裹2例.结果 CT和MRI能清楚地显示动脉瘤的形状、大小.DSA及三维DSA能显示瘤颈以及与附近血管和骨质的关系.根据格拉斯骨预后评分表评分,出院时恢复优良者12例,中度病残4例,重度病残1例,无死亡病例.结论 术前有必要进行详细的影像学检查,有助于术者规划手术方法,制定个体化治疗方案,采用不同术式取得良好预后.载瘤动脉暂时性阻断、动脉瘤切开血栓清除均有助于瘤颈夹闭.血管重建技术为大脑中动脉巨大型动脉瘤的手术治疗开辟了新途径,明显改善了手术效果.     

多层螺旋CT血管造影对于外科处理脑动脉瘤蛛网膜下腔出血的指导作用和临床经验

目的研究多层螺旋CT血管造影(MSCTA)诊断脑动脉瘤的临床应用。方法选择我院2014年10月~2017年1月收治的60例蛛网膜下腔出血疑似脑动脉瘤患者进行的MSCTA检查的临床资料,其中15例行保守治疗;其余45例行MSCTA患者经过外科处理,包括41例经DSA血管内处理,4例经开颅手术治疗。分析CTA的诊断准确性、应用价值和作者的使用经验。结果CTA:所有患者中45例MSCTA诊断脑动脉瘤共47个,DSA及开颅术发现脑动脉瘤49个,诊断符合率为95.9%;CTA与DSA对瘤体长轴、瘤体短轴与瘤颈进行分析显示,两种检测方法的检测数据均无明显差异,P0.05。结论对于颅内动脉瘤患者采取MSCTA检测的临床意义重要,有利于显示出患者颅内动脉瘤的瘤体大小与瘤颈,诊断方法安全、可靠。     

Unruptured cerebral aneurysms; the features of cases undetected with MR angiography

With the development of MRI and MRA, many unruptured aneurysms have been detected and treated. Nevertheless, not a few false-positive and false-negative cases are found. We investigate aneurysms that were suspected after screening MRA at the neurosurgical outpatient clinic and the features of aneurysms detected not with MRA but with DSA were studied. Seventy-six patients (85 aneurysms) were suspected due to screening MRA and DSA was performed in 64 (71 aneurysms) of them. Correct diagnosis of cerebral aneurysms with MRA was obtained in 44 patients (45 aneurysms, 63.4%), while false-negative cases were found in 17 patients (plus 20 aneurysms) and false-positive cases in 7 patients (10 aneurysms). The accuracy was 97.2% in ACA, 93% in MCA, 94.4% in VA-BA, and 78.9% in IC, while the sensitivity 100%, 88.2%, 81.8%, 64.7% and the specificity 96.5%, 94.4%, 96.7%, 91.9%, respectively. The features of aneurysms correctly diagnosed with MRA were relatively large ACA, including AcoA, MCA and VA-BA aneurysms, whereas the features of aneurysms undetected with MRA were small IC aneurysms (1-3mm in diameter), especially at the C2-3 portion. These aneurysms at the C2-3 portion or at unusual portions tended to be difficult to detect even with 3D-CTA. Though most of the aneurysms detected with DSA but not with MRA tended to be small and not interventionally treated in the present study, we should pay attention to the fact that these aneurysms are overlooked despite the possibility that they may become enlarged or rupture. Though ruptured aneurysms were surgically treated with only MRA or 3D-CTA without conventional angiography in these days, we recommend the examination of the unruptured cases, which are usually asymptomatic and not hasty, with precise inspection by target MIP, high-performance 3D-CTA or DSA.     

MRA volume rendering for surgical planning of unruptured intracranial cerebral aneurysms

A volume rendering (VR) three-dimensional reconstruction method was applied to magnetic resonance angiography (MRA), to investigate its usefulness for surgical planning of unruptured cerebral aneurysms (ANs). Twelve cases with anterior communicating artery (Acom) ANs and 16 cases with middle cerebral artery (MCA) ANs underwent MRA VR, preoperatively. There were 10 male and 18 female patients, whose ages were ranged from 37 to 73 (mean 58) years old. Appearance of ANs and surrounding vascular structures on MRA VR was compared with that on maximum intensity projection (MIP) image, three-dimensional digital subtraction angiogram (3D-DSA), and intraoperative findings. In all cases, MRA VR delineated aneurysms more clearly compared to MIP. In MCAANs, MRA VR provided enough information for surgical planning, compatible with 3D-DSA. In Acom ANs, MRA VR delineated bilateral A1, A2 and Acom complex simultaneously without temporary vascular occlusion. MRA VR may have a complementary role in preoperative evaluation of unruptured ANs with other modalities such as 3D-DSA.     

Wall Imaging of Cerebral Aneurysms with a Modified Surface-Rendering Technique of Spiral CT

Summary ? Background. There has been no detailed documentation of the advantages of three-dimensional (3D) wall imaging of cerebral aneurysms. The usefulness of such endoscopic images obtained with modified spiral computed tomography angiography (CTA) was therefore examined in comparison with conventional spiral CTA and digital subtraction angiography (DSA).  Methods. Fifteen of 45 patients who underwent conventional spiral CTA in our department in the past 4 years, were further studied with a technical modification of surface-rendering reconstruction in spiral CT. Endoscopic images were obtained by regulating the lower and higher thresholds of spiral CT scans in processing. Digital subtraction angiography was also performed for 14 of the 15 patients. The 3D wall images of the cerebral aneurysms were assessed in comparison with findings from conventional CTA and DSA.  Findings. The true orifice of the aneurysms could be visualized with the endoscopic mode in all of the 15 cases. In paraclinoid aneurysms, particularly below the anterior clinoid process, the relationships to associated vessels and bone structures were more clearly disclosed with this mode. The endoscopic images of aneurysms with rigid clots or neighboring distended veins were not as adversely affected as conventional CTA. In 4 of the 15 the wall imaging precisely located the branches arising from the dome of aneurysms which DSA could not.  Interpretation. Wall imaging of complex or small cerebral aneurysms provided valuable information on their relationships to associated arteries and surrounding bony structures. The endoscopic mode, a simple modification of surface rendering, is easily available in commercial CT processing packages.     

双源Flash扫描模式CTA结合迭代重建诊断脑血管病变

目的探讨第二代双源Flash扫描模式CTA结合迭代重建诊断脑血管病变的临床应用价值。方法回顾性分析105例接受双源Flash扫描模式结合迭代重建脑血管CTA的疑诊脑血管病变患者的资料。以3D-DSA为金标准,计算Flash扫描模式CTA诊断脑血管病变的敏感度、特异度、阳性预测值、阴性预测值及准确率。比较3D-DSA与Flash扫描模式CTA诊断脑血管病变的差异,计算双源Flash扫描模式CTA的辐射剂量及对比剂用量。结果 105例中,Flash扫描模式CTA诊断60例共73个脑动脉瘤,其中微小动脉瘤24个;诊断13例脉动静脉畸形(AVM);检出颈内动脉海绵窦瘘5例、静脉畸形2例,脑动脉狭窄9例,烟雾病6例。以3D-DSA为金标准,CTA误诊微小动脉瘤2例,漏诊1例位于大脑中动脉远端区域的AVM。Flash扫描模式CTA诊断脑血管病变的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为98.94%(93/94)、81.82%(9/11)、97.89%(93/95)、90.00%(9/10)和97.14%(102/105),辐射剂量为(231.9±13.2)mGy·cm,对比剂用量为(49.32±2.54)ml。结论脑部Flash扫描模式CTA结合迭代重建可快速、准确诊断脑血管病变,同时辐射剂量低、对比剂用量少。     

Utility of 320-detector row CT for diagnosis and therapeutic strategy for paraclinoid and intracavernous aneurysms

Background

The aim of this study was (1) to assess the diagnostic accuracy of 320-detector row computed tomography (CT) for paraclinoid and intracavernous aneurysms, and (2) to investigate whether this method provides sufficient information for surgery.

Methods

A total of 14 patients with 16 unruptured proximal ICA aneurysms underwent three-dimensional CT angiography (3D-CTA) fusion imaging, which was created by superimposing 3D-CT venography data and/or 3D-bone data onto 3D-CTA data using 320-detector row CT, magnetic resonance imaging (MRI), and 3D digital subtraction angiography (DSA). The images of each modality were assessed using intraoperative findings as the reference standard.

Results

All aneurysms were clearly visualized on 320-detector row CT. Bone subtraction and arterio-venous discrimination were accurate. On 3D-CTA fusion images, 11 aneurysms were diagnosed as “extracavernous” and five as “intracavernous”. No discordance in aneurysm location between the 3D-CTA fusion images and the intraoperative findings was found. In contrast, discordance between MRI and intraoperative findings were found in five of the 16 cases (31 %), which was significantly more frequent than with 3D-CTA (p?=?0.043). The findings DSA, which was performed in nine patients, were also in excellent agreement with the intraoperative findings. However, 3D-CTA fusion imaging provided more comprehensive information, including venous and osseous structures, than 3D-DSA. The 320-detector row CTA after surgery demonstrated a clear relationship between the clip and aneurysmal neck with notably few artifacts, which suggested the utility of this modality for postoperative assessment.

Conclusions

The 320-detector row CT provided high accuracy for the diagnosis of paraclinoid and intracavernous aneurysms. This technique also provided comprehensive depiction of the aneurysms and surrounding structures. Therefore, this modality might be useful for the diagnosis of the paraclinoid and intracavernous aneurysms and for developing a surgical treatment plan.     

选择性腹腔动脉造影及介入栓塞在下消化道出血中的应用价值

探讨急性下消化道大出血的诊断和治疗方法。方法１９９５年１０月以来采用选择性腹腔动脉造影及介入栓塞来诊断及治疗急性下消化道大出血１３例。结果１３例病人经１４次选择性腹腔动脉造影,１２例发现出血动脉,阳性率９２％。