磁共振血管成像在诊断颅内动脉瘤中的应用

目的 研究磁共振血管成像(MRA)诊断颅内动脉瘤的原理、方法及临床价值.方法 选择经DSA证实为颅内动脉瘤的患者50例,行三维MRA及MRI检查,全部病例均经手术证实.结果 MRA对颅内动脉瘤的敏感性为90%,结合MRI,敏感性达97%,较准确显示瘤径＞3 mm的动脉瘤.结论 MRA作为一种无创、安全的检查方法,能清晰显示颅内动脉瘤的瘤体及载瘤动脉,敏感性高,是颅内动脉瘤的首选诊断方法.     

颅内动脉瘤三维CT血管成像的临床研究

目的 评价和对比3D-CTA、MRA和DSA对颅内动脉瘤诊断的临床价值。方法 对96例可疑动脉瘤患者行3D-CTA,MRA和DSA检查。结果 共发现129个动脉瘤。3D-CTA发现的最小动脉瘤大小为1.6mm×1.7mm×2.0mm。3D-CTA对动脉瘤诊断的灵敏性和特异性均为100％,而MRA则分别为95.3％和97.6％,DSA为100％和97.7％;对载瘤动脉和分枝动脉的形态描述明显优于MRA和DSA(分别为P<0.05和P<0.01);在阐明动脉瘤颈的形态上明显优于MRA和DSA(P<0.01);对动脉瘤血栓化和钙化的检出率明显高于MRA和DSA(P<0.001)。3D—CTA在108例(83.7％)动脉瘤临床治疗方案的选择上提供了重要依据。结论 3D—CTA在动脉瘤检出及其特征描述上优于MRA和DSA。3D—CTA对颅内动脉瘤的临床治疗有重要的指导作用。     

数字减影脑血管造影及磁共振血管成像对烟雾病的诊断价值

目的:评价数字减影血管造影(DSA)和磁共振血管成像(MRA)对烟雾病的诊断价值。方法:对12例烟雾病患者进行DSA和MRA检查和回顾性分析。结果:DSA能直观、准确表现狭窄及闭塞血管,以及颅底毛细血管网;由于失位相和饱和效应以及小血管流空效应,导致MRA对血管狭窄或闭塞过高评价,细小血管不能充分显影。结论:MRA可提示大血管的狭窄和闭塞,同DSA相结合,可明确烟雾病的诊断。     

磁共振静脉血管成像在脑静脉窦血栓形成诊断中的应用

目的 评价2D-TOF法磁共振静脉血管成像(MRV)在脑静脉窦血栓形成(CVST)诊断中的价值。方法 对10例CVST患者进行2D-TOP法MRV检查，并与MRI和数字减影血管造影(DSA)结果进行对照研究。结果 10例患者均为多发性CVST，最常累及上矢状窦和横窦。在MRV上CVST的直接征像为发育正常的静脉窦不显影、狭窄或再通后的模糊影，间接征像为病变以远侧枝血管形成、深部静脉明显扩张或其他引流静脉显现。本组MRV结果与DSA比较具有较高的一致性，且在血管变异的鉴别及对血栓的动态观察上要优于DSA。结论 MRV可替代DSA作为CVST诊断和随访的首选检查方法。     

3D-TOF法MRA诊断颅内动脉瘤的临床研究

目的研究3D—TOF(三维时间飞跃)法MRA诊断颅内动脉瘤的敏感性及其影响因素。方法35例颅内动脉瘤患者同时行3D—TOF法MRA、MRI及DSA检查,两名神经放射医师盲法分析图象,研究:3D—TOF法MRA诊断动脉瘤的敏感性。结果35例43个动脉瘤MRA发现36个,敏感性为83.7%,小动脉瘤及多发动脉瘤的诊断率较低,动脉瘤的部位也是影响诊断率的一个因素。结论虽然MRA在诊断颅内动脉瘤上具有较高的敏感性,但更为准确详细的信息仍需要DSA提供。     

CT血管造影在脑动脉瘤手术和栓塞中的价值

目的评估CT血管造影(CTA)在脑动脉瘤(AN)手术和栓塞中的临床价值.方法回顾211例行CTA检查并进行了手术或栓塞治疗的AN,196例患者同期接受了数字减影血管造影(DSA)检查.所有患者根据CTA的结果确定治疗方案和指导手术或栓塞的进行.结果 7例CTA出现技术性失误,其余CTA影像均被手术或栓塞所证实.CTA发现了DSA漏诊的2例小型AN.CTA提供的AN的部位、瘤体、瘤颈、瘤体/瘤颈比等参数,有利于早期确定治疗方案.66例行夹闭术,依据CTA所模拟的手术入路影像均可顺利找到AN,CTA能有效地提供AN与载瘤动脉、周围分支及颅底骨结构之间的三维关系信息.145例行栓塞治疗,CTA的结果均被DSA所证实,对前交通、基底动脉顶端AN,CTA均准确指导导引导管进入的方向,能清晰显示瘤颈的投射角度和瘤体瘤颈比,辅助确定工作角度和是否需要支架植入.结论 CTA有助于AN治疗方案地迅速确定,为早期治疗提供确切依据和指导信息,对AN手术或栓塞具有重要的价值.     

磁共振血管成像在低场强磁共振诊断颅内动脉瘤中的价值

目的：探讨磁共振血管成像（MRA）技术在低场强磁共振设备中诊断颅内动脉瘤的价值。方法：对16位29－60岁无明显诱因蛛网膜下腔出血患者运用三维时间飞跃法磁共振血管成像技术（3D TOF MRA）行颅内动脉血管成像检查。结果：16例患者均为单发动脉瘤，均手术证实。结论：在低场强磁共振设备中运用血管成像技术诊断颅内动脉瘤能为其手术治疗提供客观有价值的依据，且无放射性，无创伤，不需要对比剂。     

多层螺旋CT血管造影在颅内动脉瘤诊断和治疗中的应用

一、多层螺旋CT及多层螺旋CT血管造影多层螺旋CT(multislice helical computerized tomography,MSCT)指采用宽探测器技术,即探测器排列数增加,具有4层以上探测器的螺旋CT。它是在1998年北美放射年会上首次正式推出的,是继1972年X线计算机断层摄影(computedtomography,CT)进入临床应用和1991年单层螺旋CT(singleslice helical computed tomography,SSCT)研制成功之后,CT发展史上的第三座里程碑。常规螺旋CT扫描采用准直宽的扇形X线束,单排探测器,每旋转1w得到1个层面图像。而MSCT采用可调节宽度的锥形X线束,根据拟采集的层厚选…     

三维CT血管造影在颅内动脉瘤诊治中的临床价值

目的探讨三维CT血管造影(3D-CTA)在颅内动脉瘤诊治中的临床应用价值。方法回顾性分析自2006年1月至2009年3月以来72例颅内动脉瘤患者的3D-CTA及DSA影像学资料,3D-CTA及DSA图像分别由两位神经外科医师及放射科医师采用双盲法进行对比分析。结果经手术证实72例患者共85个动脉瘤,其中单发动脉瘤61例;多发动脉瘤11例,9例发现2个动脉瘤,2例发现3个动脉瘤。3D-CTA发现67例80个动脉瘤,而DSA发现70例83个动脉瘤。动脉瘤体最大径及瘤颈宽度的测量值在CTA与DSA组间比较无显著性差异(P0.05)。3D-CTA的敏感性及特异性分别为97.65%及94.12%,而DSA的敏感性及特异性则分别为98.82%及97.65%,两组间也无显著差异(P均0.05)。结论 3D-CTA是一种快速、价廉的无创性检查技术,对颅内动脉瘤诊断的敏感性及特异性较高,并可准确显示动脉瘤的位置、形态及大小,较好评估动脉瘤体、载瘤动脉及周围血管之间的关系,从而为选择适当的手术治疗方案提供了可靠的直观依据。     

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。     

螺旋CT血管造影在脑动脉瘤诊断及治疗中的应用兼与MR血管造影比较

目的探讨无创性的螺旋CT血管造影(SCTA)与MR血管造影(MRA)对脑动脉瘤的诊断价值以及对治疗的指导价值,并对两者作比较。方法28例病人同时行SCTA、MRA、DSA,以DSA作为金标准,对SCTA与MRA作比较。结果①23例行SCTA及时间飞跃法(TOF)MRA者,SCTA诊断脑动脉瘤的准确性高于TOFMRA(P<0.05)。②SCTA较TOFMRA测量脑动脉瘤的最大径准确性高(P<0.01),TOFMRA测量值常偏小。③SCTA测量的栓塞治疗最佳投照角度与DSA符合率94.7%。④动态增强(DCE)MRA的图像清晰度及价值与SCTA相似。结论SCTA对体积小、破裂出血的脑动脉瘤的诊断准确性以及对动脉瘤测量的精确性高于TOFMRA,SCTA可较准确地测量动脉瘤栓塞治疗的最佳投照角度,DECMRA是脑动脉瘤电解可脱弹簧圈栓塞术后随访的较好方法,DCEMRA的实用价值与SCTA相似。     

双源CTA与DSA诊断颅内动脉瘤的对比分析

目的对比分析双源CT血管成像(CTA)及DSA对颅内动脉瘤的检测效果,评估双源CTA对颅内动脉瘤的诊断价值。方法 2015年6月至2016年6月收治自发性蛛网膜下腔出血40例,均在入院1周内完善头部双源CTA及DSA检查。结果双源CTA及DSA均检出动脉瘤44个,两种方法显示动脉瘤部位一致,两种检查方法显示动脉瘤大小无统计学差异(P0.05)。DSA显示微小动脉瘤5个,接近颅底部位的颈内动脉C3~C5段动脉瘤4个;双源CTA对颈内动脉C3~C5段动脉瘤的检出率为100%,对微小动脉瘤的检出率为100%。结论双源CTA检查快捷、简单、准确,为颅内动脉瘤的一种快速检查方法。     

Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels

Abstract

Objective: To report the results of the Neuroform, Leo and Wingspan stents used to treat cerebral aneurysms in vessels of small caliber.

Materials and methods: We reviewed 12 cases of wide-necked aneurysms treated with stent deployment into small cerebral vessels with diameter range from 1·0 to 2·5 mm. All stents were deployed for aneurysm treatment in combination with coiling. Aneurysm locations were as follows: A1 (n = 4), anterior communicating artery (n = 2), A2 (n = 1), M1 (n = 2), M2 (n = 1) and P1 (n = 2). Clinical follow-up ranged from 3 to 12 months. Imaging follow-up (range: 3-6 months) was performed with cerebral angiography.

Results: Twelve self-expanding stents (six Neuroform stents, three Leo stents and three Wingspan stents) were deployed for 12 wide-necked cerebral aneurysms arising from vessels measuring 2·5 mm in diameter. Eleven procedures were successfully performed without immediate or delayed device-related complications with one stent misplacement. Intraprocedural thrombus developed within the stent in one patient. There were no clinical neurological symptoms related to the treated vessel territory at clinical follow-up.

Conclusion: Development of newer small endovascular devices, such as Neuroform, Leo and Wingspan stents, allow access and ability to treat lesions farther out in the smaller cerebral vessels.     

110例脑梗死患者的全脑数字减影血管造影的临床研究

目的探讨脑梗死患者与颅内-颅外段动脉狭窄或闭塞的关系及其临床意义。方法选择符合脑梗死诊断标准的110例患者行全脑数字减影血管造影(DSA)检查,对颈内动脉系统脑梗死(ICA-CI)和椎-基动脉系统脑梗死(VB-CI)患者的颅内-颅外段动脉狭窄或闭塞进行分析比较。结果 110例脑梗死患者中85例(77.27%)有动脉狭窄或闭塞。其中25例(22.73%)为单纯颅外段动脉狭窄或闭塞,41例(37.27%)为单纯颅内段动脉狭窄或闭塞,19例(17.27%)为颅内-颅外段动脉多发性狭窄或闭塞。DSA共检出动脉狭窄或闭塞173支,颅外动脉段狭窄或闭塞65支(37.57%),颅内段动脉狭窄或闭塞108支(62.43%)。颅内段动脉狭窄或闭塞发生率(62.43%)明显高于颅外段动脉(37.57%)。颅外段动脉狭窄或闭塞的好发部位依次为:颈内动脉颅外段26支(15.03%),椎动脉颅外段19支(10.98%),颈总动脉14支(8.09%),锁骨下动脉6支(3.47%)。颅内段动脉狭窄或闭塞的好发部位依次为:大脑中动脉37支(21.39%),颈内动脉颅内段25支(14.45%),椎动脉颅内段18支(10.40%),大脑后动脉11支(6.36%),大脑前动脉9支(5.20%),基底动脉8支(4.62%)。ICA-CI组单纯颅外段动脉狭窄或闭塞高于VB-CI组(P<0.05),ICA-CI组单纯颅内段动脉狭窄或闭塞高于VB-CI组(P<0.01),ICA-CI组颅内-颅外段动脉多发狭窄或闭塞低于VB-CI组(P<0.05)。ICA-CI组单纯颅内段动脉狭窄或闭塞高于单纯颅外段动脉窄或闭塞,VB-CI组单纯颅内动脉段狭窄或闭塞高于单纯颅外动脉段狭窄或闭塞(P<0.05)。动脉狭窄及粥样硬化斑块与年龄、高血压、低血压、糖尿病、高甘油三酯(TG)、高总胆固醇(TC)、高低密度脂蛋白(LDL-C)、冠心病、肥胖、吸烟、酗洒有密切关系(均P<0.05)。结论 DSA检查有助于脑梗死患者的颅内-颅外段主要供血动脉狭窄与闭塞诊断,对脑梗死的治疗有重要指导作用。     

Kissing aneurysms of the distal anterior cerebral artery

Kissing aneurysms, a particular type of multiple aneurysm are rare. A kissing aneurysms was identified at the distal anterior cerebral artery (ACA) in a 59-year-old male patient diagnosed with subarachnoid hemorrhage (SAH). The use of three-dimensional intracranial CT angiograms revealed that kissing aneurysms (that is, an aneurysm with a bilateral symmetrical mirror image) were located at the distal ACA and diffuse SAH in basal, sylvian, and interhemispheric cisterns. Both conventional carotid angiograms showed that both distal ACA aneurysms were seen separately on both internal carotid angiograms. Two aneurysms were observed simultaneously on carotid compression of either side. Some particular cautions required in diagnosing and treating kissing aneurysms are discussed, together with a literature review.     

CTA、DSA在颅内动脉瘤诊治中价值的对比研究

目的探讨CT血管造影(CTA)和数字减影血管造影(DSA)诊治颅内动脉瘤的价值。方法对56例颅内动脉瘤患者行CTA检查,分析动脉瘤显示情况,并将结果与DSA和/或手术所见比较。部分动脉瘤病例术后行CTA和DSA复查。结果 DSA确诊56例动脉瘤患者,发现68个动脉瘤。CTA显示51例(63个)动脉瘤,敏感性为91.07%(51/56),特异性为100%。CTA能明确动脉瘤的部位、大小、瘤颈及瘤体与载瘤动脉的空间关系,但不能很好地反映动脉瘤夹闭情况。结论 DSA目前仍然是临床诊断颅内动脉瘤及术后随访检查的"金标准"。CTA对于临床疑诊为颅内动脉瘤患者可作为一种筛选方法,但不适合动脉瘤术后的复查。     

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.     

Screening and treatment of unruptured cerebral aneurysms

Thirty outpatients with unruptured cerebral aneurysms screened by computed angiotomography have been analysed and followed up in our clinic since 1979.

Seventeen were men and the age range was 41 to 74 years old (mean 57.7 years). Patients had no or only mild neurological symptoms, such as headache, sensorimotor or speech impairment and others, which were scarcely related to the unruptured aneurysms themselves. It is important to realize that these first aneurysms which remain unruptured, have a primary significance to the individual in the protective aspect of an initial subarachnoid haemorrhage. Operation was successfully performed in fifteen patients. Transient aggravation of previous diseases, e.g. cerebral infarction, occurred in three after operation. Follow-up studies of fifteen patients without operation revealed no change in eight and some worsening or death due to other or previous diseases in six. One died of aneurysmal rupture in the 5th month after its detection. Because of the low operative risk, we advocate the operative treatment of unruptured aneurysms, following careful selection of the indicated patients.     

Matrix metalloproteinases 2 and 9 in human atherosclerotic and non-atherosclerotic cerebral aneurysms

Matrix metalloproteinases 2 and 9 (MMP 2 and -9) have been implicated in the pathogenesis of atherosclerosis and aneurysm formation. The goal of the study was to establish the role of these metalloproteinases in both human atherosclerotic and non-atherosclerotic cerebral aneurysms. Eleven cerebral aneurysms (four atherosclerotic, seven non-atherosclerotic) were immunohistochemically stained for MMP 2 and -9. As controls, atherosclerotic and normal Circle of Willis arteries were similarly immunostained. All specimens were retrieved at autopsy and were paraffin-embedded. In order to evaluate the real MMP 2 and -9 activities, gelatin zymography was also performed in only two available specimens of non-atherosclerotic intracranial aneurysms, because of the relative unavailability of fresh intracranial aneurysm tissue (i.e. reluctance to excise the aneurysm fundus at surgery). Our data establish that MMP 2 and -9 were expressed minimally or not at all in normal Circle of Willis arteries but were strongly expressed in medial smooth muscle cells of atherosclerotic Circle of Willis arteries. In the aneurysm group, both MMP 2 and -9 were strongly expressed in the atherosclerotic aneurysms, but MMP 2 alone was detected in the non-atherosclerotic aneurysms. Zymography revealed a weak enzyme activity correlating to MMP 9 standard recombinant protein. MMP 2 activity was not demonstrated in either specimen. This study shows that the expression of MMP 2 and -9 is associated with atherosclerosis, be it in aneurysmal or non-aneurysmal cerebral vessels but MMP 2 appears to be specifically expressed in aneurysms devoid of atherosclerosis perhaps suggesting a pathogenic role for MMP 2 in the alteration of the extracellular matrix of cerebral arteries during aneurysm formation.