多层螺旋CT三维血管成像在颅内动脉瘤夹闭术后随访中的初步应用

目的探讨多层螺旋CT三维血管成像（MS3D-CTA）在颅内动脉瘤夹闭术后随访中的应用价值。方法回顾性分析16例颅内动脉瘤患者夹闭术前后的MS3D-CTA资料。用16层螺旋CT扫描仪获得原始图像，然后采用容积重组（VR）、薄层最大密度投影（MIP）和多平面重组（MPR）技术对图像进行后处理。结果16例颅内动脉瘤夹闭术后复查共发现17个动脉瘤夹，其中后交通动脉瘤6例，前交通动脉瘤5例，大脑中动脉瘤4例，胼周动脉瘤1例2个动脉瘤夹。MS 3D-CTA检查未见异常7例，动脉瘤残留2例，载瘤动脉局限性狭窄4例，伴有血管痉挛3例，所有患者均未见载瘤动脉闭塞及动脉瘤夹滑脱移位征象。VR上12例清晰显示瘤夹及载瘤动脉的三维空间关系，3例较清晰显示，1例胼周动脉瘤使用2个瘤夹者线束硬化性伪影明显而显示较差；动脉瘤夹的形态及大小在薄层MIP与MPR上均能准确显示，但瘤夹与载瘤动脉的三维空间感较差。结论MS3D-CTA是颅内动脉瘤夹闭术后快捷、安全和有效的随访检查手段，VR与薄层MIP、MPR结合可更好地显示颅内动脉瘤夹闭术后改变。

Primitive experience of three dimensional multi-slice spiral CT angiography for the follow-up of intracranial aneurysm clipping

Objective To evaluate multi-slice three-dimensional CT angiography (MS 3D-CTA) for the follow-up of intracranial aneurysm clipping.Methods MS 3D-CTA of 16 patients with intracranial aneurysm clipping were retrospectively analyzed.The patients were scanned on a 16-slice spiral CT(GE Lightspeed pro).Volume rendering(VR),thin maximum intensity projection(thin MIP) and multi-planar reconstruction (MPR) were employed in image postprocessing in all cases.Results There were 17 clips in the 16 patients with aneurysm clipping.Six clips were located at the posterior communicating artery,5 at the anterior communicating artery,4 at the middle cerebral artery,and the remaining 2 clips were located at the pericallosal artery in 1 patient.There were no abnormalities found in the aneurysm clipping region in 7 cases by MS 3D-CTA.There were residual aneurysm in 2 cases,parent artery stenosis in 4 cases,and artery spasm in 3 cases.There was no parent artery occlusion and clip displacement in all cases.VR showed excellent 3D spacial relations between the clip and parent artery in 12 cases,and showed good relations in 3 cases.The 1 case with 2 clips in the pericallosal artery showed heavy beam-hardening artifacts.The size and shape of aneurysm clips were clearly depicted by MPR and thin MIP,while 3D spacial relation of aneurysm clip and parent artery were poorly showed.Conclusion MS 3D-CTA is a safe and efficient method for the follow-up of intracranialaneurysm clipping.Combined VR with MPR or thin MIP can well reveal postoperative changes after aneurysm clipping.