DSA与3D-CTA在颅内动脉瘤诊断及治疗中的临床探讨

目的评价DSA与3D-CTA在诊断颅内动脉瘤方面的优缺点。方法26例自发性蛛网膜下腔出血患者，24例接受了DSA与3D-CTA检查，另2例在出血后2-4h内仅行CTA检查。DSA检查的时相为出血后12-30d；3D—cTA检查的时相为出血后2h-30d。分析DSA、3D—CTA与术中显微镜下所见动脉瘤的大小、部位、瘤颈、瘤体指向及周边重要穿支血管的吻合程度。结果26例自发性蛛网膜下腔出血患者共发现34个颅内动脉瘤，其中行DSA检查的24例患者中共发现28个动脉瘤，检出率约82％，而3D-CTA发现32个动脉瘤，检出率94％；2例出血后数小时内3D-CTA检查发现2个动脉瘤。以上动脉瘤均经手术证实，CTA在动脉瘤大小、瘤颈宽度上与术中实际情况吻合程度更高。结论DSA是诊断颅内动脉率的金指标，但有一定的假阴性率；3D-CTA无创、经济、不受血管痉挛的影响，对直径3mm以上的动脉瘤的检出率可能优于DSA，对动脉瘤的部位、瘤颈、瘤体、载瘤动脉及周边结构的三维显示更有助于制定手术方案。

Clinical research of DSA and 3D-CTA in intracranial aneurysms

[Objective] To evaluate the clinical accuracy of DSA and 3D-CTA(three diamensinal CT angiography) in diagnostic and treatment intracranial aneurysms. [Methods] 24 patients suspected with intracranial aneurysms underwent DSA and 3D-CTA, the other patients only underwent 3D-CTA. [Results] 26 patients suspected with 34 intracranial aneurysms, 28 aneurysms were detected DSA and 32 aneurysms were detected by 3D-CTA meanwhile, another 2 aneurysms only were detected by 3D-CTA. A total of 34 aneurysms underwent surgical treatment. [Conclusions] Although DSA still is the gold standard to diagnose the aneurysms, but 3D-CTA enables the surgeon to understand the 3D structure of intracranial aneurysms and is very useful in planning the surgical treatment on aneurysms.