多层螺旋CT三维血管成像诊断颅内动脉瘤

目的探讨多层螺旋CT三维血管成像(3D-MSCTA)诊断颅内动脉瘤的价值。 方法 对31例3D-MSCTA诊断的颅内动脉瘤进行回顾性分析。其中4例经手术证实, 13例经脑血管数字减影血管造影(DSA)证实。MSCTA图像后处理包括容积重建(VR)、最大密度投影(MIP)、多方位重组(MPR)及曲面重建(CPR)。结果 3D-MSCTA在31例患者中, 共发现38个动脉瘤。其中3例为两个动脉瘤, 2例为三个动脉瘤。38个动脉瘤中大脑中动脉瘤9个, 大脑前动脉瘤7个, 大脑后动脉瘤2个, 后交通动脉瘤3个, 颈内动脉瘤12个, 基底动脉瘤3个, 胼周动脉瘤1个, 小脑上动脉瘤1个。MSCTA均清晰显示瘤体的大小、位置、形态及瘤颈宽度、瘤轴指向、载瘤动脉、动脉瘤与周围重要解剖结构的关系。动脉瘤最小1.0mm×1.3mm, 最大59mm×73mm。有DSA资料对照的13例中, MSCTA发现16个动脉瘤中DSA只发现13个, 另外DSA发现1个动脉瘤而MSCTA漏诊。3D-MSCTA诊断颅内动脉瘤的敏感度、特异度、阳性预测值、阴性预测值分别为92.9%、97.1%、81.3%、99.0%。结论 3D-MSCTA在颅内动脉瘤临床诊断和术后随访中有较高的应用价值。

Three-dimensional multi-slice spiral CT angiography in diagnosis of intracranial aneurysms

Objective To assess the diagnostic value of three dimensional multi -slice spiral computed tomography angiography （ 3D - MSCTA） in detecting intracranial aneurysms. Methods The imaging data of 31 patients with intracranial aneurysms were retrospectively analyzed, 13 patients were performed with DSA,4 patients were conformed by operation. Reconstruction types of MSCTA included volume rendering （VR）, maximum intensity projection（ MIP）, multi - plane reformation（MPR） and curved plane reconstruction（CPR）. Results In the 31 cases ,38 aneurysms were detected by MSCTA. Three cases had two aneurysms,two cases had three aneurysms. The locations of the aneurysm were middle cerebral artery（ n = 9）, anterior cerebral artery （ n = 7）, posterior cerebral artery（ n = 2）, posterior communicating artery（ n = 3 ）, carotid（ n = 12）, basilar artery（ n = 3 ）, corpus peripheral artery （ n = 1 ）, superior cerebellar artery （ n = 1 ）. The minimum diameter was 1.0 mm × 1.3 mm, The maximum diameter was 59 mm × 73 mm. MSCTA can precisely display the size, configuration and direction of intracranial aneurysms,and their anatomic connection with surrounding vessels and bones using 3D post -processing methods. Compared with DSA,16 aneurysms were detected by MSCTA and 13 by DSA. One aneurysms was detected by DSA and was normal in MSCTA. The sensitivity, specificity, positive predictive value and negative predictive value for detection of aneurysms with MSCTA were 92.9% ,97.1%, 81.3% and99% respectively. Conclusion 3D - MSCTA has important significance in the diagnosis and operation for intracranial aneurysms.