CT血管造影在急性自发性脑出血中的临床应用价值

目的评价CT血管造影（CTA）在急性自发性脑出血中的临床应用价值。方法对CT检查提示急性自发性脑出血的71例（蛛网膜下腔出血23例，脑内血肿21例，脑室出血9例，混合性出血18例）。患者进一步行CTA检查。其中47例随后进行了DSA检查。根据检查结果综合考虑后，行急症脑室外引流术11例，脑内血肿清除术8例，动脉瘤栓塞术8例，动脉瘤夹闭术9例，保守治疗35例。结果CTA检查提示动脉瘤28例，动静脉畸形（AVM）16例，烟雾病3例，CTA检查阴性24例。DSA检查提示动脉瘤23例，AVM8例，烟雾病5例，脑膜动静脉瘘2例，DSA阴性9例（其中1例CTA检查为动脉瘤）。本组患者共死亡3例，重残6例。结论CTA对于自发性脑内血肿的治疗有重要的指导意义，特别对于是否采取急症手术及手术方法的选择更有价值。对于动脉瘤的诊断有帮助，但决定治疗方案还需要进一步行DSA检查。

Application of CT angiogrsphy in acute spontaneous intracerebral hemorrhage

Objective To evaluate the application of CT angiography （CTA） in the acute spontaneous intracerebral hemorrhage. Methods Seventy one cases were indicated by CT scan as acute spontaneous intracerebral hemorrhage including 23 cases of subarachnoid hemorrhages, 9 ventricle hemorrhages, 21 intracerebral hematomas, 18 mixed intracerebral hemorrhages. All 71 patients further underwent CTA examination, among them 47 received DSA examination afterwards. Eleven patients underwent external ventricular drainage, 8 patients received intracerebral hematomas evacuation, aneurysm embolization was performed in 8 patients, and 9 cases had aneurysm clipping operation, 31 cases were treated by medicine only. Results Among 71 cases CTA showed： 28 cases of aneurysms, 16 AVMs, 3 Moyamoya Diseases, 24 negatives. Among 47 cases DSA demonstrated： 23 aneurysms, 8 AVMs, 5 Moyamoya diseases, 2 DAVFs, 9 negative （including 1 aneurysm diagnosed by CTA）. In this series 3 patients died, 6 patients got severe disability. Conclusion CTA examination is of value in differential diagnosis and treatment of acute intracerebral hematoma. Aneurysm can be diagnosed by CTA, but DSA is still needed for choice of treatment modalities.