3D-CTA、3D-DSA评估脑动脉瘤患者行显微外科夹闭术的治疗效果

目的 以三维CT血管成像（3D-CTA）、三维脑血管造影（3D-DSA）检查评估脑动脉瘤患者行显微外科夹闭术的效果,为合理选择脑动脉瘤显微外科夹闭后的评估方法提供依据.方法 对25例行显微外科夹闭术后的脑动脉瘤患者行3D-CTA、3D-DSA复查,分别对有无动脉瘤夹闭不全、动脉瘤颈残留/成角、载瘤动脉狭窄、载瘤动脉闭塞和动脉瘤夹滑脱移位5种影像学特征进行分析、赋值和计分,并进行统计分析.结果 25例患者中,术后3D-CTA复查显示载瘤动脉狭窄2例,未见动脉瘤夹闭不全、动脉瘤颈残留/成角、载瘤动脉闭塞和动脉瘤夹滑脱移位;3D-DSA复查显示动脉瘤夹闭不全1例、动脉瘤颈残留/成角1例、载瘤动脉狭窄2例,未见载瘤动脉闭塞和动脉瘤夹滑脱移位.两种检查方法的评分比较无统计学差异（P＞0.05）.结论 3D-CTA对显微外科夹闭术后的总体评价效果与3D-DSA具有可比性,但其对动脉瘤夹闭不全和动脉瘤颈残留/成角的显示不及3D-DSA.

Assessment of microsurgical clipping efficacy in treating cerebral aneurysms by 3D-CTA and 3D-DSA

Objectve To assess the efficacy of microsurgical clipping in treating cerebral aneurysm by three dimensional CT angiography （3D-CTA） and three dimensional digital subtraction angiography （3D-DSA）,and therefore to provide a proper modality for pest-operative evaluation after microsurgical clipping of cerebral aneurysm.Methods Twentyfive patients with cerebral aneurysms underwent 3D-CTA and 3D-DSA after microsurgical clipping surgery and whether having the following imaging features,including incomplete clipped aneurysm,residual aneurysm neck/cornered neck,patent artery stenosis,patent artery occlusion,and shift or slip of aneurysm clip,were screened,scored and statistically analyzed.Results In the 25 patients examined,postoperative 3D-CTA revealed two cases of patent artery stenosis and no case of incomplete clipped aneurysm,residual aneurysm neck/cornered neck,patent artery occlusion,or shift and slip of aneurysm clip; while peostoperative 3D-DSA demonstrated one case of incomplete clipped aneurysm,one case of residual aneurysm neck/cornered neck,two cases of patent artery stenosis and no case of patent artery occlusion or shift and slip of aneurysm clip.Nosignificant differences were found between both diagnostic modalities （P ＞ 0.05）.Conclusion The postoperative assessment efficacy in cerebral aneurysm clipping with 3D-CTA is comparable to 3D-DSA,but the 3D-CTA is probably less effective in demonstrating incomplete clipped aneurysm and residual aneurysm neck/cornered neck than 3D-DSA.