头颈联合CTA对动脉成窗变异的评价

目的探讨头颈联合64排容积CT血管造影(CTA)对动脉成窗变异的诊断价值及其临床意义。方法搜集行64排容积CT头颈联合CTA的患者资料1042例,对获得图像进行容积再现(volume rendering,VR)、最大密度投影(maximum intensity projection,MIP)、多平面重组(multiplanar reconstruction,MPR)及曲面重组(curve planarreconstruction,CPR)等后处理,比较各组图像对头颈部动脉成窗变异的显示情况,分析头颈部动脉成窗变异的检出率、部位、CTA表现、与周围结构的关系及伴发其他血管性病变等。结果 1042例中,头颈动脉成窗变异58例,共计61处,位于基底动脉24处、椎动脉16处、大脑前动脉12处、前交通动脉区7处、大脑中动脉2处。根据CTA表现分型,42处为裂隙型,19处为凸透镜型。58例成窗变异中12例伴有颅内动脉瘤,8例伴有椎动脉发育不良,1例伴有右侧椎动脉行径异常,10例伴胚胎型大脑后动脉。结论头颈联合CTA可以立体、直观、准确地显示头颈部动脉成窗变异的位置、形态、毗邻关系、有无伴发其他血管性病变等,有助于指导临床对伴发的血管性病变制定合理的治疗方案。

The Application of Cranio-Cervical CT Angiography in the Evaluation of Intracranial and Cervical Arterial Fenestration

Objective To evaluate the clinical value of cranio-cervical CT angiography in the diagnosis of intracranial and cervical artery fenestration.Methods 1042 cranio-cervical CT angiography(CTA) were retrospectively reviewed.All images were reconstructed with volume rendering,maximum intensity projection,multiplanar reconstruction and curve planar reconstruction.The fenestration’s frequency,location,cranio-cervical CTA features,surrounding structures of lesions,and other associated vascular anomalies were analyzed.Results In 58 patients,61 fenestrations were detected.24The fenestrations were located in basilar artery in 24 cases,in vertebral artery in 16,in anterior cerebral artery in 12,in anterior communicating artery area in 7,and in middle cerebral artery in 2 cases.In 61 fenestrated arteries,42 of them were small with a slit-like shape,and 19 were relatively large with a convex-lens-like shape.In all fenestration patients,the lesions associated with intracranial aneurysms in 12 patients,hypoplastic vertebral artery in 8,fetal origin of the posterior cerebral artery in 10,and aberrant entrance position into the transverse foramen of the right vertebral artery in 1 case.Conclusion Cranio-cervical CTA can directly,clearly and exactly demonstrate the location,shape,and adjacent structures of intracranial and cervical arterial fenestration.Other associated vascular anomalies can also be demonstrated.It can help making therapeutic regimen for the associated vascular anomalies.