MRA在颅内动脉瘤诊断中的应用价值

目的 总结磁共振血管造影术诊断和手术治疗颅内动脉瘤的方法。方法 25例经CT诊断为蛛网膜下腔出血的患者施行磁共振血管造影术,扫描范围包括双侧椎动脉颅内段和颈内动脉岩骨段部位。出血后首次行磁共振血管造影术的时间为4h～50d,平均10.9d;手术前Hunt-Hess分级为Ⅰ级4例,Ⅱ级11例,Ⅲ级4例,Ⅳ级5例和Ⅴ级1例。结果 25例患者中,首次磁共振血管造影阳性者18例,2例有伪影者经再次复查证实,共检出22个动脉瘤;4例阴性;1例可疑者经脑血管造影证实。20例磁共振血管造影阳性患者,16例经手术证实。GOS评估良好16例,中残2例,重残2例,昏迷4例,死亡1例。结论 应用磁共振血管造影检查诊断颅内动脉瘤,阳性检出率较高,假阳性率低,对不具备脑血管造影设备的医疗单位具有一定应用价值。

The application of MRA in diagnosing intracranial aneurysm

Objective To study the value of magnetic resonance angiography (MRA) in diagnosis and the operation technique for intracranial aneurysms (ICA). Methods A total of 25 patients diagnosed as sub-arachnoid hemorrhage (SAH) by CT were performed MRA. The scaning ranged including the intracranial segment of spinal artery and the petrosal segment of internal carotid artery. The duration between receiving first MRA and hemorrhage was 4h to 50 d (averaged 10.9 d). Preoperative Hunt and Hess grades of these patients were I in 4 cases, II in 11, Iff in 4, IV in 5 and V in one. Results Of these 25 patients, 18 cases were positive in first MRA, 2 cases with artifact were identified by rescaning and as a result 22 aneurysms were detected; 4 cases were negative, 1 suspective case was then identified by cerebroangiography. In 20 patients with positive MRA 16 cases were identified in operation. It demonstrated by evaluation with GOS there were 16 cases good, 2 moderate disablement, 2 severe disablement, 4 coma and one death. Conclusion The MRA is a valuable technique in diagnosis of ICA with high positive and low pseudopositive rate, especially in clinics where the equipments of cerebroangiography is not available.