16层螺旋CT血管成像在脑动脉瘤诊断和治疗中的价值

目的评价16层螺旋CT血管成像（CTA）在脑动脉瘤诊断和治疗中的临床应用价值。方法382例临床怀疑脑动脉瘤的患者纳入本研究，全部行16层螺旋CTA检查。运用最大密度投影和容积再现技术评价动脉瘤的形态、大小、位置和瘤颈形态及动脉瘤与颅骨和周围血管的关系，并根据16层螺旋CTA结果选择血管内治疗或外科治疗。结果382例中的203例患者发现223个脑动脉瘤。16层螺旋CTA诊断所有动脉瘤的敏感性、特异性和准确性分别是97．8％、97．8％和97．8％。16层螺旋CTA对于动脉瘤诊断的准确性与DSA的结果差别没有统计学意义。通过CTA评价认为136个动脉瘤适合行血管内治疗，其中132个动脉瘤成功栓塞。53个动脉瘤适合外科夹闭治疗，术中认为所有的动脉瘤被成功夹闭。结论16层螺旋CTA在脑动脉瘤诊断方面具有很高的准确性，并且能够提供足够的诊断信息指导动脉瘤的治疗。

Value of 16-slice CT angiography in diagnosis and treatment of cerebral aneurysms

Objective To assess the clinical value of 16-slice CT angiography (CTA) in diagnosis and treatment of cerebral aneurysms. Methods 382 patients were included in the study and successively underwent 16-slice CTA examination for suspected cere- bral aneurysms. Using maximum-intensity projections and volume-rendering techniques, two neuroradiologists performed the morphology, size and location of the aneurysms, neck geometry, and the relationship of aneurysms to bone structures and adjacent branch vessels. Sixteen-slice CTA images were used to determine whether the aneurysm was suitable for endovascular treatment or whether a surgical procedure was preferable. Results 223 cerebral aneurysms were identified in 203 of the 382 patients. The sensitivity, specificity, and accuracy of 16-slice CTA in detecting all aneurysms were 97.8%, 97.8%, and 97.8, respectively, on a per-aneurysm basis. There was no statistically significant difference in accuracy between 16-slice CTA and DSA. 136 aneurysms were suitable for endovascular coiling by using the 16-slice CTA images, and 132 aneurysms were success- fully treated by endovascular coiling. Forty-eight aneurysms were suitable for surgical clipping, and all aneurysms were deemed completely occluded during surgical clipping. Conclusion Sixteen-slice CTA is a highly accurate imaging examination for the diagnosis of cerebral aneurysms, and it can provide sufficient diagnostic information in guiding the treatment of aneurysms.