彩色多普勒超声联合磁共振血管造影检查对老年颅内动脉瘤的诊断价值

目的探讨彩色多普勒超声(TCCS)联合磁共振血管造影(MRA)检查对老年颅内动脉瘤的诊断价值。方法选取2015年1月至2016年7月期间本院疑诊为老年颅内动脉瘤120例,均进行TCCS、MRA与DSA检查,以DSA检查的结果作为金标准。结果 Kappa检验显示TCCS、MRA与DSA检查具有较高的一致性。TCCS联合MRA检查诊断老年颅内动脉瘤的灵敏度、阴性预测值、准确度明显高于TCCS或MRA检查(P0.05)。结论 TCCS联合MRA检查对老年颅内动脉瘤诊断价值更显著。     

颅内动脉瘤电解可脱性弹簧圈栓塞后MRA随访

目的评估磁共振血管造影(MRA)在动脉瘤弹簧圈栓塞后随访中的价值.方法回顾栓塞后3个月同期进行了MRA和数字减影血管造影(DSA)复查的37例41个动脉瘤,两者时间间隔在3d以内,以DSA为标准,观察有无瘤颈残留以及弹簧圈内有无血流残留.结果 41个动脉瘤中,DSA发现有29个完全闭塞,9个可见瘤颈残留,3个动脉瘤内有对比剂.MRA见31个动脉瘤完全闭塞,8个可见瘤颈残留,2个可见瘤内存在血流.本组中假阴性2例,无假阳性.结论 MRA是脑动脉瘤弹簧圈栓塞后的一种无创、可靠、快速的影像学随访方法,有助于监测动脉瘤颈残留和弹簧圈内血流残留.     

256层螺旋3D-CT血管造影与DSA对颅内动脉瘤诊断的对比研究

目的探讨256层螺旋3D-CT血管造影(3D-CT angiography,3D-CTA)与数字减影血管造影(digital subtractionangiography,DSA)对颅内动脉瘤的诊断价值。方法收集24例怀疑动脉瘤的病人,同时行256层螺旋3D-CTA及DSA检查,以DSA结果为金标准,评估3D-CTA检查的灵敏度,并比较两种影像学诊断方法在瘤体最长径测量上的差异。结果 3D-CTA发现动脉瘤的灵敏度为92.6%,两种影像学诊断方法在瘤体最长径测量上差异无统计学意义(P>0.05)。结论 256层螺旋3D-CTA对颅内动脉瘤的诊断灵敏度高,且能提供精确的信息和优质图像,但仍有部分漏诊。将CTA与DSA技术结合能更全面准确的诊断和观察颅内动脉瘤。     

CT血管造影与3D-DSA对囊状未破裂脑动脉瘤的对比研究

目的评估静脉注入造影剂的CTA与3D-DSA对于诊断颅内动脉瘤准确性的对比评价。方法 13例通过血管造影偶然发现的15个颅内囊性动脉瘤。对于每个患者,我们均进行静脉注射造影剂的CT血管造影和传统的血管造影包括三维旋转数字减影血管造影。在后处理过程中,应用多平面重建技术对于每个动脉瘤的最大直径、瘤颈直径、动脉瘤高度、最大宽度、凸起高度、载瘤动脉直径和载瘤动脉与动脉瘤顶端之间的夹角进行仔细测量。结果 3D-DSA和静脉注射造影剂的CT血管造影都能提供高质量的图像而没有运动伪像。所有参数的测量表明二者对颅内动脉瘤形态的诊断具有极高的相似性(P≤0.001)。结论 CTA是一种可行的、可视的、无创性的诊断囊状脑动脉瘤的手段并且通过评估动脉瘤的大小和几何形态可以提供与传统三维旋转数字减影血管造影术相媲美的可靠的诊断信息。此初步结果提示CTA可能成为脑动脉瘤介入治疗前取代DSA的一个有前途的诊断方法。     

64排螺旋CT血管造影在脑动脉瘤诊断中的价值

目的探讨64排螺旋CT血管造影在动脉瘤诊断中的价值。方法回顾性分析2012-01—2014-01我院收治的42例脑动脉瘤患者,采用CT血管造影(CTA)和数字血管成像(DSA)进行检查并比较分析。结果 CT血管造影的诊断结果准确性与DSA诊断结果准确无明显差异(P0.05),CTA血管造影显示脑动脉瘤的大小、结构、部位符合手术结果。2种方法患者接受度比较差异有统计学意义(P0.05)。结论 CT血管造影在脑动脉瘤诊断中准确率高,且对患者痛苦少,接受度较高,应用价值较高。     

缺血性脑血管病颅内脑动脉狭窄的TCD、MRA对比检测

目的评价TCD、MRA诊断缺血性脑血管病患者颅内脑动脉狭窄的临床应用价值。方法203例颞窗良好的缺血性脑血管病患者行经颅多普勒(TCD)检测发现颅内脑动脉狭窄,全部病例3d内再行磁共振血管造影(MRA)检查,5例行数字减影血管造影(DSA)。结果TCD检测发现狭窄大脑中动脉236支,MRA检查发现狭窄大脑中动脉225支．TCD与MRA诊断相符大脑中动脉数为219支。结论TCD和MRA是诊断颅内脑动脉狭窄准确性较好的无创性检查方法,两者联合应用评价颅内脑动脉狭窄精确性更高。     

颅内静脉窦血栓形成临床和磁共振及血管造影

目的分析颅内静脉窦血栓形成(CVST)的临床特点,磁共振成像(MRI)、磁共振血管造影(MRA)及数字减影血管造影(DSA)对其诊断的价值及早期诊断、早期治疗的意义.方法总结22例经MRI、MRA、DSA确诊为颅内静脉窦血栓形成的住院病人的临床资料及影像学特点.结果 10例病人无明确病因,发病时间4～10年,临床表现主要有颅内压增高及皮质受损表现.21例病人经MRI、MRA确诊,未确诊1例经DSA检查确诊.本组11例发病＜1个月的病人经静脉窦插管溶栓术及抗凝等治疗,症状和体征完全恢复或明显好转.本组9例行静脉窦插管溶栓术,5例病人症状和体征完全恢复.结论 CVST临床表现无特异性,MRI、MRA及DSA检查可确诊.发病早期(＜1个月)予静脉窦插管溶栓术,症状和体征完全恢复机会很大.     

320排CT血管造影检测颅内动脉瘤的临床研究

目的探讨320排CT血管造影(CTA)对颅内动脉瘤的诊断价值。方法回顾性分析16例脑血管病人的临床资料,均先行320排CTA检查、DSA和三维旋转血管造影(3DRA)检查。所得图像均由2位神经外科专家行双盲法分析。结果 320排CTA发现动脉瘤13例、共15个;动脉瘤直径1.4~6.4 mm,平均为3.4 mm。DSA和3DRA发现动脉瘤14例、共17个;动脉瘤直径0.97～6.16 mm,平均为3.62 mm。经统计学分析,320排CTA与DSA和3DRA对颅内动脉瘤直径的测定差别有统计学意义(P<0.05)。结论 320排CTA检测颅内动脉瘤具有可行性,但可能会漏诊极小的动脉瘤,无法取代DSA和3DRA金标准的地位。     

CT血管造影、DSA在脑动脉瘤诊断治疗中的比较

目的　探讨 CT血管造影 (CTA)在脑动脉瘤诊断治疗中的价值。方法　对 2 1例可疑动脉瘤患者进行 CTA检查 ,8例同时行数字减影血管造影 (DSA)检查 ,与 CTA检查结果比较 ,并与术中所见进行对照。结果　2 1例患者共检出 2 3个动脉瘤并经手术证实 ,其中假阳性动脉瘤 1个。 CTA可以显示动脉瘤的三维解剖结构 ,为手术提供便利。结论　 CTA可以作为蛛网膜下腔出血及可疑动脉瘤患者的初选检查方法。但不能连续观测脑循环过程及进行血管内操作。     

三维数字减影血管造影在脑动脉瘤治疗和随访中的应用

目的　探讨三维数字减影血管造影 (3DDSA)在脑动脉瘤血管内栓塞治疗及随访中的价值。方法　对 4 9例疑诊或确诊动脉瘤的病例 ,术前、栓塞术中行 3DDSA检查 ,其中 10例作 3DDSA随访。结果　 4 9例中经 3DDSA证实共检出 4 7例 5 3个动脉瘤 ,3DDSA对动脉瘤形状、瘤颈及瘤颈与载瘤血管关系能更好地显示 ,准确判断动脉瘤血管内栓塞的可行性 ,并为栓塞治疗提供最佳工作角度。 12例病人因 3DDSA检查而改变了原来的治疗方法。3DDSA尚可准确判断动脉瘤的栓塞程度及有无复发。结论　 3DDSA可提高颅内动脉瘤血管内栓塞的安全性 ,并有助于随访研究。     

头颅双能量血管造影（DE-CTA）与时间剪影血管造影的比较

【摘要】目的 通过对DSCT头颅DE-CTA与Neuro-DSA的对比研究,探讨DE-CTA的优势和不足。材料与方法 DSCT 头颅CTA检查正常者300例,随机分为A、B两组,A组200例行DE-CTA扫描;B组100例行Neuro-DSA扫描。对A、B两组血管图像质量、辐射剂量、后处理方法、扫描和后处理时间及数据的容量进行比较分析。结果1. A、B两组血管图像质量无统计学差异（P>0.05）,两组中图像质量Ⅰ级者明显多于其它等级, 2. A、B两组辐射剂、时间和数据量有统计学差异（P值均<0.05）,DE-CTA增强扫描时间长于Neuro-DSA组,数据量大于Neuro-DSA。但辐射剂量、完成检查所需时间、图像减影时间低于Neuro-DSA。3. DE-CTA有5种独特的后处理重建方式,但颅底部去骨的效果Neuro-DSA优于DE-CTA。结论 1. DE-CTA和Neuro-DSA图像质量无差异,均可清晰显示脑血管,甚至细小的血管末梢。2. DE-CTA辐射剂量低于Neuro-DSA技术26.3％,减影所需时间少于Neuro-DSA技术,只需一次扫描,避免受检者移动所引起的图像配准问题。3. DE-CTA多种后处理重建方式,使图像更直观,诊断信息更丰富。     

3D-DSA、CTA在颅内动脉瘤个体化锁孔手术中的应用价值

目的 探讨三维数字减影血管造影(3D-DSA)、多排螺旋CT血管成像(CTA)技术对锁孔手术治疗颅内动脉瘤的应用价值.方法 福建医科大学附属第一医院神经外科自2007年4月至2009年6月应用3D-DSA、CTA技术分析动脉瘤的影像学特征,个体化设计锁孔手术并治疗颅内动脉瘤患者175例(192个动脉瘤),其中眶上锁孔人路38例(40个动脉瘤),翼点锁孔入路132例(146个动脉瘤),额锁孔纵裂入路3例(4个动脉瘤),颞下锁孔入路2例(2个动脉瘤),分析3D-DSA、CTA在颅内动脉瘤锁孔手术策略中的应用与意义.结果 本组患者均一次性成功完成手术,其中动脉瘤夹闭188个,动脉瘤包裹4个.术后复查DSA或CTA显示动脉瘤均夹闭满意.GOS评分显示术后良好165例,轻残6例,重残2例,死亡2例.结论 3D-DSA、CTA可清晰显示颅内动脉瘤三维形态特征,为个体化的锁孔手术入路设计提供依据,是手术成功的前提.     

Magnetic resonance angiography in moyamoya disease

Spontaneous occlusion of the circle of Willis, i.e., moyamoya disease (MMD), is a clinical disease entity angiographically characterized by progressive and bilateral stenosis of the carotid bifurcation, with a hazy collateral network at the base or convexity of the brain. Although the importance of computed tomography (CT) and conventional magnetic resonance (MR) imaging in diagnosing MMD has already been determined, conventional arteriography is still regarded as necessary for definitive diagnosis. Magnetic resonance angiography (MR-A) is a very recent vascular imaging technique which allows noninvasive and direct imaging of vessels without the use of contrast medium. We present four pediatric cases of MMD, evaluated by conventional angiography, CT, MR imaging, and MR-A. Our data demonstrate thatMR-A is successful both in allowing detection of occlusive disease of the basal portion of the internal carotid artery and large branch basal cerebral vessels and demonstrating the collateral vessels at the base of the brain. As a noninvasive procedure, MR-A promises to become a valuable alternative to classical angiography in the diagnosis of MMD.     

Detection of infundibula using three-dimensional time-of-flight magnetic resonance angiography with volume rendering at 3.0 Tesla compared to digital subtraction angiography

We aimed to prospectively evaluate the effectiveness of unenhanced, three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) with volume rendering (VR) at 3.0 Tesla in the detection of infundibula (IF). A total of 136 consecutive patients with suspected or known aneurysms detected by MRA were examined using DSA, and IF were identified. A 3D specialist adjusted window width to the appropriate threshold, took level and MR source images and performed MRA post-processing techniques, including VR and the single artery highlighting method. VR-DSA was obtained from the rotational DSA data, and two-dimensional (2D)-DSA and VR-DSA were combined as the gold standard. Three blinded readers evaluated the diagnostic sensitivity and accuracy of 3D-TOF-MRA with VR. The 2D-DSA and VR-DSA revealed 44 IF in 34 of the 136 patients and no cerebral IF in 102 patients. For MRA, sensitivity per patient for all readers ranged from 89.5% to 97.1%, while accuracy per patient ranged from 97.1% to 99.3%. Per IF sensitivity for all readers ranged from 91.7% to 97.7%, while the per IF accuracy ranged from 97.3% to 99.3%. For detection of IF at the internal carotid artery, sensitivity for all readers ranged from 89.5% to 97.1%, and accuracy from 89.5% to 97.4%. For detection of IF at the anterior choroidal arteries, sensitivity and accuracy was 100% in all patients. There were no significant differences in the sensitivity or accuracy of all readers in the detection of single and multiple IF (p > 0.05). One false-negative was found for IF by reader 1, two for reader 2 and four for reader 3. We conclude that VR 3D-TOF-MRA at 3.0 T is an ideal, non-invasive imaging exam for the detection of IF and can be used effectively in its diagnosis.     

Comparison of ultrasonography, CT angiography, and digital subtraction angiography in severe carotid stenoses

Digital subtraction angiography (DSA) is considered to be the 'gold standard' for confirmation of severe (70-99%) stenoses of internal carotid arteries (ICAs). However, it is associated with a risk of complications. The aim of this study was to assess the accuracy of ultrasonography (US), computed tomographic angiography (CTA), and their combined use for the detection and quantification of severe carotid stenoses, when compared with DSA. Severe ICA stenoses were diagnosed by US in a set of 29 patients. All patients also underwent CTA and DSA. Sensitivity, specificity, positive (PPV), negative predictive values (NPV), and Pearson's correlation coefficient were used in the evaluation of the percentage of stenosis results. Homogeneity chi2 test was applied when assessing statistical significance. Severe stenosis was diagnosed in 34 ICAs. Two ICAs with uninterpretable CTA finding were excluded. The number of ICAs with stenoses 70-99%/<70%- US 32/0; CTA 29/3; US + CTA 29/3; DSA 24/8. Pearson's correlation coefficient - US 0.601; CTA 0.725; US + CTA 0.773. Sensitivity/specificity/PPV/NPV - US 1.0/0.75/0.75/xxx; CTA 1.0/0.844/0.828/1.0; US + CTA 1.0/0.844/0.828/1.0. Homogeneity chi2 test results - US, P = 0.002; CTA, P = 0.098; US + CTAG, P = 0.098. US in combination with CTA can be used for relatively secure diagnostics of severe ICA stenoses. Thus, invasive DSA can be avoided in a substantial number of patients.     

Neurological complications of cerebral angiography

We report a prospective study of 218 consecutive patients undergoing cerebral diagnostical angiography, before during and 24 hours after the procedure, to identify the neurological complication rate and the risk factors related to the patients and to the procedure. We observed 15 neurologic accidents (6.9%) with permanent sequelae in one case (0.4%). Two risk factors proved to correlate significantly with accidents, i.e. the time that the catheter remained within a vessel and difficulty in performing the procedure.

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Sommario Abbiamo studiato in modo prospettico 218 pazienti consecutivi sottoposti ad esame angiografico cerebrale, prima-durante e dopo 24 ore dall'esame, per identificare l'incidenza di complicazioni neurologiche e i fattori di rischio in relazione al paziente ed all'esame stesso. Abbiamo osservato 15 complicazioni neurologiche (6.9%) con deficit permanente in un caso (0,4%). Due sono i fattori di rischio significativi: il tempo di permanenza del catetere nel vaso e la difficoltà nell'esecuzione dell'esame.

     

16层螺旋CT 3D-CTA在颅内动脉瘤中的诊断及临床应用价值

目的探讨三维CT血管造影（three dimensional computed tomographic angiography，3D-CTA）在颅内动脉瘤的临床应用及其价值。方法对自发性蛛网膜下腔出血及怀疑颅内动脉瘤的患者53例，使用SIEMENS SOMATOM Sensation 16层螺旋CT扫描仪行3D-CTA检查（时间在发病后4h～3d），并行数字减影血管造影（digital subtraction angiography，DSA）检查；3D-CTA图像与DSA图像由神经外科医师和放射科医师用双盲法共同进行分析。结果经3DICTA、DSA和手术共同证实发现44例共49个动脉瘤，动脉瘤大小为1．7～25mm，其中单发动脉瘤36例，多发5例（1例为3个动脉瘤，4例为2个动脉瘤）；在44例动脉瘤患者中3D-CTA发现42例47个动脉瘤；DSA发现43例48个动脉瘤；动脉瘤的瘤体最大径及瘤颈最大径3D-CTA测量值与DSA测量值比较无显著性差异（t=0．59和t=0．49，P均〉0．05）；53例病情轻重不一患者在行3D-CTA检查过程中病情无加重或无其他意外发生。结论3D-CTA对颅内动脉瘤具有快捷、经济、安全和微创等优点，并有通过一次注射对比剂扫描即可从任意角度观察所显示的颅内动脉瘤的细节及与骨性结构的关系等优点，但存在无法依时间顺序分别显示动脉、毛细血管和静脉，无法分清血流方向及显示一些重要的小血管和重要的穿通支如脉络膜前动脉、丘脑穿通动脉等，也无法在血管内操作等不足之处；在诊断和治疗颅内动脉瘤的应用中与DSA检查互补也可得到颅内动脉瘤更完整的信息。     

Hemifacial spasm: magnetic resonance angiography

Twenty-three consecutive patients with hemifacial spasm were studied. Magnetic resonance imaging angiography of the brain was performed in 20 patients and 15 controls. The angiograms were evaluated by two independent observers and blinded for side-location of the spasm. Contact between an artery from the vertebrobasilar circulation and the intracranial part of the facial nerve was observed ipsilaterally to the spasm in 17 patients (85%) and in two of 30 control half-brains (7%), respectively. Treatment is discussed. The study confirms that arterial relation to the facial nerve root is the most frequent cause of hemifacial spasm. Magnetic resonance imaging is recommended to exclude mass lesions in the posterior cranial fossa, and magnetic resonance angiography is recommended in preoperative evaluation and in research.     

320排CTA对硬脊膜动静脉瘘的诊断价值

目的 探讨320排CT血管成像(CTA)对硬脊膜动静脉瘘(SDAVF)的诊治价值.方法 回顾性分析11例SDAVF病人的临床资料,均行320排CTA及DSA检查,以病变的定性诊断、供血动脉、瘘口、引流静脉的显示情况及手术治疗效果等作为观察指标进行分析.结果 320排CTA对11例病人均做出正确诊断,DSA首次检查漏诊2例,经行320排CTA获得相关图像信息后再行DSA检查发现病变.所有病人经手术治疗后随访3个月～2年,短期预后均良好,但术后9～12个月出现神经功能障碍加重3例.结论 320排CTA可良好地立体显示SDAVF病灶的特征及其周围的骨性解剖结构,但其不能动态显示病灶的血流动力学改变,尚不能取代DSA检查.     

病毒性脑炎患者脑血管造影的改变

目的探讨病毒性脑炎患者脑血管造影的改变。方法应用数字减影血管造影(DSA)系统对5例单纯疱疹病毒性脑炎和2例Epstein-Barr病毒性脑炎患者进行全脑血管造影检查,并与对照组(10例头痛患者)进行比较。结果病毒性脑炎患者DSA检查均异常,表现为“激惹”式血循环速度明显加快,整个脑动静脉循环时间平均6.71s,而对照组DSA检查均正常,整个脑动静脉循环时间为10.25s,两组比较差异有显著性(P<0.05)。结论病毒性脑炎的脑血管造影检查可见脑血循环速度明显加快,其对病毒性脑炎的诊断有一定价值。