颅内动脉瘤电解可脱性弹簧圈栓塞术后随访观察

目的　评价颅内动脉瘤电解可脱性弹簧圈 (GDC)栓塞治疗的中、远期疗效。方法　采用GDC栓塞 131例共 134枚颅内动脉瘤 ,其中前交通动脉瘤 39枚 ,后交通动脉瘤 4 5枚 ,颈内动脉虹吸段动脉瘤 19枚 ,大脑中动脉瘤 14枚 ,大脑前动脉瘤 3枚 ,后循环动脉瘤 9枚 ,其他部位 5枚。宽颈动脉瘤 (瘤颈宽度 >4mm或瘤体颈比率 <2 ) 39枚 ,狭颈动脉瘤 79枚 ,瘤颈显示不清者 16枚。栓塞术后 15个月内随访DSA ,以与栓塞后即时DSA比较其变化。结果　在 39枚宽颈动脉瘤和 79枚狭颈动脉瘤中 ,完全、近完全闭塞者分别为 30枚 (76 92 % )和 75枚 (94 94 % ) ,两者差异有非常显著性意义(χ2 =8 6 4 3,P <0 0 1)。栓塞后即时完全、近完全闭塞的 118枚动脉瘤中 ,术后不同时期随访DSA显示均无变化 ;栓塞后即时部分疏松填塞的 16枚动脉瘤中 ,随访DSA显示动脉瘤缩小者 3枚 ,无变化者4枚 ,再开放扩大者 9枚。结论　GDC致密、完全栓塞颅内动脉瘤的近、中期疗效肯定 ,但定期随访行DSA检查是必要的 ,尤其是部分疏松填塞者 ,对于复发的病例 ,可再行GDC栓塞     

三维容积重建技术在栓塞后颅内动脉瘤DSA随访中的价值探讨

目的 探讨三维容积重建技术(3D-VRT)在弹簧圈栓塞后颅内动脉瘤的DSA随访中的应用价值.方法 采用介入弹簧圈栓塞技术治疗109例患者、共121枚颅内动脉瘤,术后所有患者均经历至少1次DSA随访.2名神经放射学专家分别对术后即刻和随访中的二维DSA造影(2D-DSA)、旋转血管造影(rotational angiography,RA)和3D-VRT成像进行分析,比较3种成像技术显示动脉瘤残留的能力.术后随访结果分为完全栓塞、瘤颈残留和瘤腔残留.若患者经历1次以上造影随访,评估最后一次随访结果.采用Kruskal-Wallis等级秩和检验对3种成像技术的评价结果进行比较,Kappa检验评价2名观察者结果的一致性.结果 121枚动脉瘤术后3D-VRT显示90枚完全栓塞,26枚瘤颈残留,5枚瘤腔残留.在随访造影中,2D·DSA发现完全栓塞、瘤颈残留和瘤腔残留分别为92枚、20枚和9枚,RA发现例数为86枚、23枚和12枚,3D-VRT为68枚、30枚和23枚,3组间比较差异有统计学意义(X2=14.052,P=0.000 9).2名观察者对于2D-DSA、RA和3D.VRT观察结果的Kappa值分别为0.545、0.582和0.748.结论 3D-VRT技术能够明显提高DSA造影随访中动脉瘤残留的检出率,值得在栓塞动脉瘤的造影随访中推广使用.     

Neuroform3支架在急诊血管内栓塞破裂性颅内宽颈动脉瘤中的应用

目的 评价急诊血管内Neuroform3支架辅助下可解脱弹簧圈栓塞破裂的颅内宽颈动脉瘤的疗效和中期随访.方法 回顾性分析最近18个月急诊介入栓塞治疗的破裂出血性颅内动脉瘤48例,其中26例在72 h内实施Neuroform3支架辅助下弹簧圈栓塞术.其中3例动脉瘤位于大脑前动脉A1段,3例位于大脑中动脉M1和M2段,13例位于后交通,2例位于颈内动脉眼动脉段,2例位于基底动脉顶端,2例位于椎动脉V2和V4段,1例位于小脑后下动脉;3例在第1枚弹簧圈释放后植入支架,1例在第2枚弹簧圈释放后植入支架,2例在第4枚弹簧圈释放后植入支架,10例在第1枚弹簧圈无法在瘤腔内成篮后植入支架,其余10例先植入支架再进行弹簧圈栓塞,所有微导管均通过支架网眼进入动脉瘤.结果 所有病例均成功释放支架(100%),覆盖了瘤颈,同期行弹簧圈填塞动脉瘤.术后即刻造影显示动脉瘤完全栓塞23例(88.5%),次全栓塞3例(11.5%);术中1例支架轻度回撤,无血栓事件和动脉瘤再破裂出血发生,所有患者均恢复良好出院.栓塞术后随访到23例,至少复查1次脑血管造影,最多复查3次;完全致密栓塞14例(60.8%)动脉瘤均末显影,6例瘤颈少许显影病例中3例(11.5%)存在血栓形成,次全栓塞1例(3.3%)瘤体再通,另外2例始终稳定,所有病例载瘤动脉通畅,狭窄2例(7.7%),临床上无任何症状,术后所有患者均无再出血.结论 急症血管内应用Neuroform3支架辅助弹簧圈栓塞破裂出血的颅内宽颈动脉瘤足方便的、安全的和有效的.     

64层3D-CTA与3D-DSA对颅内动脉瘤评价的对比研究

目的 对比评价64层螺旋CT三维血管造影(3D-CTA)与三维数字减影血管造影(3D-DSA)对颅内动脉瘤的诊断价值.方法 28例临床怀疑颅内动脉瘤的患者均行64层螺旋CT血管造影和DSA,CT三维后处理主要包括容积重建(VR)及最大密度投影(MIP).常规二维DSA检查后,对可疑病变血管行旋转DSA检查,应用三维工作软件行3D后处理,比较3D-CTA与3D-DSA对动脉瘤显示的价值.结果 28例病例中22例CTA和DSA均显示动脉瘤并经手术或栓塞证实,其中1例CTA和DSA显示单个动脉瘤,手术证实为2个动脉瘤,1例CTA显示假阳性.3D-CTA与3D-DSA均能清楚显示动脉瘤形状、瘤径指向、瘤体直径、瘤颈、载瘤动脉、瘤体穿动脉情况,两者无明显差异.结论 64层3D-CTA在颅内动脉瘤诊断及细节显示上与3D-DSA无明显差异,一定程度上应能替代血管造影,指导临床治疗.     

三维动态增强MR血管造影对颅内动脉瘤的诊断价值

目的 评价三维动态增强磁共振血管造影(3D DCE-MRA)在颅内动脉瘤诊断中的价值。方法 对54例高度怀疑有颅内动脉瘤的病人行3D DCE-MRA检查，随后行DSA造影及可行的血管内栓塞治疗。3D DCE-MRA用超快速三维梯度回波序列(3D FISP)(钆喷替酸葡甲胺0．2mmol／kg,1次扫描时间10s)，工作站上三维重建，比较3D DCE-MRA及常规DSA在显示动脉瘤、瘤颈及与载瘤动脉关系上的优劣，及对血管内栓塞治疗的价值。结果 39例脑动脉瘤患者共45个动脉瘤，3D DCE-MRA对动脉瘤的敏感度为96％，特异度73％，准确度90％。3D DCE-MRA对动脉瘤细节及瘤颈的显示明显优于常规DSA，尤其是颈内动脉海绵窦部及椎动脉近小脑后下动脉的动脉瘤，可指导DSA显示动脉瘤方向及预先制定治疗方案。但对周边部及动脉分岔处小动脉瘤的诊断应谨慎。结论3D DCE-MRA能无创有效地诊断颅内动脉瘤，所提供的三维信息对治疗方案的制定具有极大帮助。当诊断有怀疑时，应结合DSA检查。     

Matrix可脱弹簧圈栓塞治疗颅内动脉瘤

目的　探讨Matrix可脱弹簧圈血管内栓塞治疗颅内动脉瘤的临床价值。方法　对 5 1例共 5 6枚颅内动脉瘤施行血管内Matrix可脱弹簧圈栓塞治疗 ,5 1例患者按Hunt Hess分级 :Ⅰ级 15例、Ⅱ级 2 4例、Ⅲ级 8例、Ⅳ级 4例 ,所有病例均经CT扫描和DSA造影诊断。 4例宽颈动脉瘤和 2例梭形动脉瘤采用Neuroform支架结合Matrix可脱弹簧圈栓塞治疗。结果　应用Matrix可脱弹簧圈栓塞成功 4 8例 5 3枚动脉瘤 ,占 94 .3% ;3例因严重血管痉挛导致微导管无法到位而实施动脉瘤夹闭术 ;1例弹簧圈尾端残留于载瘤动脉 ,但未导致临床后果 ;无死亡及严重并发症 ;4 8例随访 3～ 12个月无再次出血和并发症。结论　Matrix可脱弹簧圈血管内能够有效栓塞颅内各部位动脉瘤 ,术中有明显的促进动脉瘤腔内形成血栓的作用 ,术后促进血管内皮细胞生长覆盖动脉瘤颈口的作用。可以防止再次破裂出血。     

颅内破裂囊状动脉瘤的血管内治疗

目的 探讨颅内破裂囊状动脉瘤的血管内治疗的价值和技术.方法 回顾性分析上海市静安区中心医院和上海华山医院2004年7月-2008年5月.因自发性颅内出血患者就诊,经全脑DSA检查,确诊颅内囊状动脉瘤138例患者,共149枚动脉瘤.(剔除<2mm的微小动脉瘤患者);并行血管内栓塞治疗.结果 本组128枚(86%)囊性动脉瘤完全栓塞;12枚(8%)95%栓塞;9枚(6%)栓塞小于95%,其中4个为宽颈动脉瘤,5个为宽颈大动脉瘤.138例患者中93例(67.4%)患者进行了全脑血管造影随访,DSA随访从6～36个月,平均16.8个月.其中4例(4.3%)复发,但均无再次破裂出血发生.结论 颅内囊性动脉瘤血管内治疗并中期随访提示颅内破裂囊性动脉瘤介入治疗是一种安全、有效的治疗方法;破裂囊性动脉瘤栓塞的重点是栓塞瘤颈和载瘤动脉相邻的真性动脉瘤,远端如形成动脉瘤囊泡或假囊,栓塞时无需栓塞或致密栓塞.长期效果有待进一步随访.     

颅内动脉瘤破裂早期介入治疗的临床价值

目的探讨颅内动脉瘤破裂后早期行数字减影血管造影(DSA)诊断价值并介入栓塞治疗的临床价值。方法对在我院治疗的38例自发性蛛网膜下腔出血患者行头颅CT扫描及早期DSA检查,并行血管内微弹簧圈栓塞治疗及或手术夹闭,包括GDC34例,手术夹闭4例。38例患者按Hunt-Hess分级:Ⅰ级30例、Ⅱ级6例、Ⅲ级1例、Ⅳ级1例,所有病例均行DSA造影及CT扫描。结果 CT扫描均提示不同程度的自发性蛛网膜下腔出血;脑血管DSA造影诊断:前交通动脉瘤13例,后交通动脉瘤16例,大脑中动脉瘤7例,颈内动脉分叉部2例。介入栓塞及手术夹闭成功36例,占94.7%。36例随访3～35个月无再次出血,全部病例CT复查显示弹簧圈形态、位置无改变,30例6个月后复查DSA未见动脉瘤复发。2例后交通复杂动脉瘤介入栓塞失败,家属不愿手术治疗,他们分别于术后1周及1月后死亡。结论对颅内动脉瘤破裂患者需尽早行数字减影血管造影(DSA)作出早期诊断,早期进行弹簧圈血管内栓塞治疗;DSA在诊断,治疗及患者随访中均发挥非常重要的作用。     

支架联合弹簧圈技术栓塞颅内微小宽颈动脉瘤

目的　探讨三维 (3D)数字减影 (DSA)辅助下血管内支架联合弹簧圈 (stent coil)技术栓塞颅内微小宽颈动脉瘤的技术要点及疗效。方法　 12例瘤体 颈比值≤ 1的颅内微小宽颈动脉瘤 (瘤体最大径≤ 4 .0mm) ,全部经二维 (2D)造影及 3D重建 ,前交通动脉 2例采用双侧置管 ,微导管头端到位后 ,通过对侧导引导管内释放颅内自膨胀支架Neuroform ,再通过微导管使用弹簧圈塞动脉瘤。后交通动脉 8例 ,小脑后下动脉动脉起始部 2例 ,先释放支架覆盖瘤颈 ,通过支架网眼将微导管送入动脉瘤腔使用弹簧圈栓塞 ,术后 6～ 12个月进行临床和影像学随访。结果　 12例 2DDSA检查中 7例需经 3D确定为宽颈动脉瘤 ;12例全部技术成功 ,动脉瘤致密栓塞 ,载瘤动脉通畅 ;1例前交通动脉瘤栓塞后出现一过性神经功能障碍 ,经治疗后恢复正常 ,其余 11例恢复顺利。 12例临床随访 6～ 12个月 ,无动脉瘤再出血或脑血栓形成 ,7例DSA随访 ,无支架内膜增生狭窄及动脉瘤复发。结论　 3DDSA在颅内微小宽颈动脉瘤的诊断和介入治疗中有重要的辅助作用 ,支架～弹簧圈技术栓塞颅内微小宽颈动脉瘤疗效确实 ,颅内专用支架为特殊部位宽颈动脉瘤的介入治疗提供了方便。     

3D DSA在颅内动脉瘤诊疗中的应用价值

目的 探讨3D DSA在颅内动脉瘤诊断和血管内介入治疗中的临床应用价值.方法 11例蛛网膜下腔出血患者（经CT证实）,分别进行常规DSA与3D DSA造影,9例进行血管内介入治疗.结果 常规DSA一般能显示存在动脉瘤病变,极少数能明确显示瘤颈和载瘤动脉的关系.3D DSA能清晰显示颅内动脉瘤瘤体,瘤颈及其与载瘤动脉的关系,显示动脉瘤结构的能力比常规DSA明显提高,提示血管内介入治疗的可行性,并指导制定治疗方案.结论 3D DSA对颅内动脉瘤的诊断和血管内介入治疗具有较高的临床应用价值.     

Intracranial aneurysms: clinical value of 3D digital subtraction angiography in the therapeutic decision and endovascular treatment

PURPOSE: To evaluate three-dimensional (3D) digital subtraction angiography (DSA) as a supplement to two-dimensional (2D) DSA in the endovascular treatment (EVT) of intracranial aneurysms. MATERIALS AND METHODS: In 22 ruptured aneurysms, neck visualization, aneurysm shape, and EVT feasibility were analyzed at 2D DSA (anteroposterior, lateral, and rotational views) and at maximum intensity projection (MIP) and surface shaded display (SSD) 3D DSA. The possibility of obtaining a working view for EVT at 3D DSA and the relevance of measurements in choosing the first coil also were assessed. RESULTS: Two-dimensional DSA images clearly depicted the aneurysm neck in four of 22 aneurysms; MIP images, in 10; and SSD images, in 21, but SSD led to overestimation of the neck size in one aneurysm. Aneurysm shape was precisely demonstrated in five of 22 aneurysms at 2D DSA, in eight at MIP, and in all cases at SSD. In two of 22 aneurysms, EVT seemed to be nonfeasible at 2D DSA; however, SSD demonstrated feasibility and EVT was successfully performed. In one aneurysm, only SSD demonstrated the extension of the neck to a parent vessel, which was proved at surgery. Working views for EVT were deduced from 3D DSA findings in 20 of 21 aneurysms. The choice of the first coil was correct in 19 of 21 aneurysms. CONCLUSION: Three-dimensional DSA is valuable for evaluating the potential for EVT, finding a working view, and performing accurate measurements.     

64层螺旋CT脑血管造影在颅内动脉瘤诊断中的应用

目的:与DSA相对照,探讨64层螺旋CT脑血管造影在颅内动脉瘤中的诊断价值。方法:对29例临床怀疑颅内动脉瘤的患者行64层螺旋CT脑血管造影(CTA)和DSA检查,使用GE64层Lightspeed VCT获得原始图像,所有病例均采用多层面重建(multiplanar reconstruction,MPR)、容积再现(volume rendering,VR)、薄层块最大密度投影(thin-slab maximumintensity projectjon,TS MIP)。后处理图像及DSA图像由2位放射科医生共同评估。结果:29例患者中,DSA证实25例共27个动脉瘤,其中2例为2个动脉瘤。与DSA结果相对照,CTA共检出25例26个动脉瘤,漏诊了1个颈出动脉瘤。CTA清晰显示了动脉瘤的形态、大小及载瘤动脉,3例动脉瘤瘤颈DSA未显示,CTA显示了全部动脉瘤的瘤颈。结论:64层CTA在颅内动脉瘤的诊断中具有极高价值,特别在显示动脉瘤瘤颈方面具有独特的优势,对临床治疗具有指导意义。     

多层螺旋CT 三维血管造影容积重建成像在颅内动脉瘤中的诊断价值

目的探讨多层面螺旋CT三维血管造影(MS 3D-CTA)容积重建(VR)技术在颅内动脉瘤中的诊断价值.方法对109例临床怀疑颅内动脉瘤的病人行MS 3D-CTA和DSA检查.使用GE Lightspeed pro 16层螺旋CT扫描仪获得原始图像,所有病例均采用VR技术对图像进行三维重建,20例同时有最大密度投影(MIP)辅助检查.VR和MIP后处理图像以及DSA图像由3位放射科医生用双盲法进行分析.结果DSA和手术证实83例共94个动脉瘤,其中单发74例,多发9例(7例2个动脉瘤,2例3个动脉瘤).VR图像上所测动脉瘤大小为1.3～32 mm,与DSA比较无显著性差异(t=1.548,P＞0.05).VR对颅内动脉瘤的敏感度为96.8%,特异度为92.9%,准确度为95.9%,阳性预测值为97.8%,阴性预测值为89.7%;DSA敏感度为97.9%,特异度为96.3%,准确度为97.5%,阳性预测值为98.9%,阴性预测值为92.9%.94个动脉瘤中,89个(94.7%)动脉瘤在VR图像上能清晰显示瘤体、瘤颈与载瘤动脉的三维空间关系,DSA为57个(60.6%).结论MS 3D-CTA VR的敏感度、特异度和准确度均较高,是一种快捷、经济和有效的检查技术.     

3D DSA在颅内动脉瘤血管内治疗中的价值

目的　对相对复杂的血管解剖结构 ,常规的二维DSA(2DDSA)不能提供诊治所需要的完整信息。三维重建技术来自旋转血管造影 ,提供了颅内动脉瘤许多有价值的信息。本研究探讨三维数字减影血管造影 (3DDSA)在颅内动脉瘤血管内治疗中的价值。方法　 2 0 0 1年 7月至 2 0 0 4年 4月我院收治的并进行 3D重建的 35 2例患者 ,共 4 31个动脉瘤。男 14 8例 ,女 2 0 4例。平均年龄 5 5岁 (15～ 87岁 )。其中 2 72例患者以自发性蛛网膜下腔出血入院 ,37例以头痛入院 ,2 6例以单纯动眼神经麻痹入院 ,17例因其他诉原因入院发现动脉榴。动脉瘤部位 :颈内动脉及后交通动脉 2 2 4枚 ,大脑前动脉及前交通动脉119枚 ,大脑中动脉 37枚 ,基底动脉 32枚 ,大脑后动脉 19枚。动脉瘤最小 2 .2mm× 2 .0mm× 1.5mm ,最大 32mm× 2 6mm× 2 0mm ,所有患者均行常规脑血管造影及旋转DSA检查 ,并行 3DDSA重建 ,其中 375个动脉瘤进行了血管内治疗。对 4 31枚动脉瘤的 3DDSA与 2DDSA图像进行比较 ,分析动脉瘤的形状、瘤颈的显示、血管内治疗的可行性、血管内治疗的工作角度及第一枚弹簧圈大小的选择。结果　与 2DDSA相比 ,3DDSA能更清晰显示动脉瘤的形状及瘤颈 ,更正确判断动脉瘤血管内治疗的可行性 ,能提供多个血管内治疗的工作角度 ,使用     

Comparison of 2D and 3D digital subtraction angiography in evaluation of intracranial aneurysms

BACKGROUND AND PURPOSE: Although digital subtraction angiography (DSA) is considered the criterion standard for depiction of intracranial aneurysms, it is often difficult to determine the relationship of overlapping vessels to aneurysms when using 2D DSA. We compared 2D and 3D DSA in evaluation of intracranial aneurysms. METHODS: Thirty-six consecutive patients with cerebral aneurysms underwent 2D and 3D DSA. After standard 2D DSA, rotational DSA was performed. Maximum intensity projection (MIP) and shaded surface display (SSD) images were created from the rotational DSA data sets. All images were assessed randomly for overall image quality, presence of aneurysm, presence of aneurysmal lobulation, visualization of aneurysmal neck, and relationship to adjacent vessels. Data analysis was conducted for 40 aneurysms treated by clip placement. RESULTS: One aneurysm that was not detected at 2D DSA was classified as uncertain on the basis of rotational DSA. All aneurysms were classified as probably or definitively present on the basis of MIP and SSD findings. Overall image quality of rotational DSA, MIP, and SSD was statistically inferior to that of the standard 2D DSA for visualization of distal arteries. However, MIP and SSD images were significantly superior to those of standard 2D DSA for all other evaluations. For detection of lobulation, SSD images were significantly superior to other images, and for visualization of aneurysmal neck and relationship to neighboring arteries, SSD images were significantly superior to those of rotational DSA. For evaluation of the relationship to neighboring arteries, MIP images were significantly superior to those of rotational DSA. CONCLUSION: Three-dimensional DSA, especially SSD, provided more detailed information for evaluating cerebral aneurysms than did standard 2D and rotational DSA.     

Three-dimensional reconstructed rotational digital subtraction angiography in planning treatment of intracranial aneurysms

We evaluated three-dimensional (3D) reconstructions of 200 ° rotational digital subtraction angiography (DSA) images for their contributions to improving the safety of endovascular embolization of intracranial aneurysms. Standard DSA and 200 ° rotational DSA were performed in 40 adult patients (aged 21–77 years) with 45 intracranial aneurysms. Information obtainable from standard DSA and 3D-DSA images about aneurysm shape and size was compared. In 40 (89 %) of the 45 aneurysms 3D-DSA gave additional information about the anatomy of the aneurysm. In 17 (43 %) of these cases aneurysm anatomy could be visualized better on 3D-DSA than on standard DSA images. In three cases only 3D-DSA images showed blood vessels originating from the aneurysm. Reconstructed 3D images were also helpful in visualizing partially clipped aneurysms. On maximum-intensity projection images it was even possible to depict previously embolized aneurysms. Blood vessels originating from the aneurysm are visible on 3D-DSA images, and even previously clipped aneurysms can be visualized well. Rotational DSA with 3D reconstruction is a helpful tool in the assessment of intracranial aneurysms. Received: 7 September 1999; Revised: 26 November 1999; Accepted: 26 November 1999     

3D angiography in the evaluation of intracranial aneurysms before and after treatment. Initial experience

PURPOSE: The aim of the study is to evaluate the advantages of 3D angiography as compared to 2D angiography in assessing intracranial aneurysms before and after treatment and, in particular, in selecting and planning the correct treatment. MATERIALS AND METHODS: Thirty intracranial aneurysms were retrospectively reviewed before and after treatment. The study population consisted of 12 men and 18 women (age range: 35-77 years; mean age: 58 years). Eighteen aneurysms were treated surgically, 10 endovascularly and 2 with combined treatment. The 2D and 3D findings before and after treatment were compared, and the pre-treatment angiographic images were compared with surgical findings. The following parameters were assessed and compared: aneurysmal sac and neck size, vascular involvement and evaluation of post-treatment residual mass. RESULTS: On the 2D DSA images, visualisation of the sac and neck was optimal in 45% and 15% of cases, adequate in 10% and 35% of cases and inadequate in 5% and 50% of cases, respectively. On the 3D DSA images, visualisation of the sac and neck was optimal in 100% of cases. Three-dimensional DSA was able to detect 8 aneurysms with vessel involvement in all cases (100%). Of these, four (50%) went undetected on 2D DSA; in two cases, two-dimensional DSA erroneously detected the presence of vascular involvement (false positive). Three-dimensional angiography proved superior to 2D angiography in the evaluation of the residual aneurysms treated with clipping. Finally, 3D DSA was able to reduce the number of radiographic projections, the quantity of contrast medium, the time and associated risks necessary for a precise evaluation of the aneurysm. CONCLUSIONS: In our first experience, 3D DSA proved useful in reducing the risks and diagnostic time as well as in selecting and planning the treatment. Moreover, it improved the operating conditions of both surgical and endovascular treatment. Technological advances in this field will enable the optimisation of the technique in terms of anatomical detail and reconstruction time.     

单个弹簧圈栓塞颅内微小动脉瘤的单中心经验

目的探讨单个弹簧圈栓塞颅内微小动脉瘤(最大径<3 mm)的可行性和疗效。方法 2001年1月至2011年1月对72例颅内微小动脉瘤患者的77个动脉瘤进行单个弹簧圈栓塞,其中动脉瘤破裂出血52例,多发性动脉瘤13例。用3D-DSA选择工作角度测量动脉瘤大小(前后径、上下径、宽颈、最大径和瘤颈)。随访脑血管造影3～88个月(平均24.8个月)。结果对所有77个微小动脉瘤成功实施了单个弹簧圈栓塞,其中10个采用球囊辅助弹簧圈栓塞,19个联合支架辅助弹簧圈栓塞。术中破裂出血7例,发生脑栓塞事件2例,术中弹簧圈移位2例。术后即刻造影示完全栓塞42个,次全栓塞30个,部分栓塞5个。除2例死亡外,所有病例进行了至少2次复查(术后3和12个月),其中再通5个,对3个进行了再次栓塞,延迟性弹簧圈移位2例。12个月后复查造影示完全栓塞61个,次全栓塞14个。结论单个弹簧圈栓塞颅内微小动脉瘤可行、安全并有效,联合支架辅助治疗可以降低其再通率。     

MR angiography at 3T versus digital subtraction angiography in the follow-up of intracranial aneurysms treated with detachable coils

BACKGROUND AND PURPOSE: Digital subtraction angiography (DSA) is used to follow-up intracranial aneurysms treated with detachable coils to identify recurrence and determine need for additional treatment. However, DSA is invasive and involves a small risk of neurologic complications. We assessed the feasibility and usefulness of 3D time-of-flight (TOF) MR angiography (MRA) performed at 3T compared with DSA for the follow-up of coil-treated intracranial aneurysms. METHODS: In a prospective study, 20 consecutive patients with 21 intracranial aneurysms treated with coils underwent DSA and nonenhanced and enhanced multiple overlapping thin-slab acquisition 3D TOF MRA at 3T on the same day at a mean follow-up of 6 months (range, 4-14 months) after coil placement. MRA images were evaluated for presence of artifacts, presence and size of aneurysm remnants and recurrences, patency of parent and branch vessels, and added value of contrast material enhancement. MRA and DSA findings were compared. RESULTS: Interobserver agreement of MRA was good, as was agreement between MRA and DSA. All three recurrences that needed additional treatment were detected with MRA. Minor disagreement occurred in four cases: three coil-treated aneurysms were scored on MRA images as having a small remnant, whereas on DSA images these aneurysms were occluded; the other aneurysm was scored on MRA images as having a small remnant, whereas on DSA images this was a small recurrence. Use of contrast material had no additional value. Coil-related MR imaging artifacts were minimal and did not interfere with evaluation of the occlusion status of the aneurysm. CONCLUSION: High-spatial-resolution 3D TOF MRA at 3T is feasible and useful in the follow-up of patients with intracranial aneurysms treated with coil placement.