螺旋CT血管造影在脑动脉瘤血管内栓塞治疗中的价值

目的 探讨螺旋CT血管造影（SCTA）在指导脑动脉瘤血管内栓塞治疗中的应用价值。方法 脑动脉瘤患者48例，行SCTA明确动脉瘤的部位、形态及与载瘤动脉、邻近其他结构的关系，选择最佳显示动脉瘤与载瘤动脉关系的角度，测量动脉瘤的瘤颈、瘤体大小及动脉瘤与载瘤动脉的夹角，以指导血管内电解可脱弹簧圈（GDC）栓塞治疗。1周内行DSA造影，合适病例行GDC栓塞治疗，将SCTA与DSA结果进行对照比较。结果 （1）SCTA检出了DSA确诊的56个脑动脉瘤中的53个（94．6％），正确诊断51个（91．1％）。（2）43个脑动脉瘤选择血管内GDC栓塞治疗，SCTA选择的血管内治疗的最佳投照角度与DSA相符41个（95．35），SCTA测量这41个动脉瘤的瘤体与载瘤动脉夹角、瘤体及瘤颈大小并分别与DSA测量值比较，差异均无显著性意义（P值均＞0．05）。SCTA选择最佳投照角度及测量数值应以最大密度投影（MIP）图像为准，结合表面遮盖法（SSD）图像。结论 SCTA不仅对脑动脉瘤的诊断准确率高，而且对动脉瘤治疗方案的制定、术前准确及血管内栓塞治疗有很高的指导价值。

Application of spiral CT angiography in endovascular embolization of cerebral aneurysms

Objective　To evaluate spiral CT angiography (SCTA) in endovascular embolization of cerebral aneurysms. Methods　SCTA was performed in 48 patients with cerebral aneurysm to clarify the site and shape of the aneurysm and the relationship between anerysm and its loading artery and other structures nearby. The optimal projection angle to demonstrate the relation between aneurysm and its loading artery was shown best by rotating the three-dimensional SCTA image. The size of the aneurysm′s neck and body and the angle between the aneurysm and its loading artery were measured at the same time. These diagnostic informations were used to guide the selection of therapy,surgical preparation and endovascular blockage with Guglielmi detachable coil (GDC). DSA was carried out within 1 week and the results were compared with SCTA in all cases. Patients suitable for endovascular therapy were embolized by GDC. Results　(1) 56 cerebral aneurysms were detected by DSA in 48 patients. SCTA found 53 aneurysms (94.6%) and diagnosed 51 correctly (91.1%). (2) The optimal projection angle selected by SCTA was identical with DSA in 41 of 43 aneurysms undergoing GDC embolization (95.3%). In these 41 aneurysms, there was no statistic differences between the measurements of SCTA and DSA about the size of the aneurysm neck and body and the angle between the aneurysm and their loading artery (P＞0.05). The MIP image should be used to select the optimal projection angle and measure the aneurysm, while the SSD image was for reference only. Conclusion　SCTA can not only diagnose cerebral aneurysms accurately but also has high directive value in making therapy plan, surgical preparation and endovascular embolization.