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目的探讨三维CT脑血管造影(3D-CTA)在诊断脑动脉瘤时的注意事项。方法回顾总结3D-CTA检查的106例蛛网膜下腔出血(SAH)病例,其中14例初次3D-CTA显示动脉瘤不清或发现颅内非动脉瘤样血管异常者,对其进行DSA脑血管造影检查。结果初次3D-CTA检查正确诊断脑动脉瘤92例,其中16例为多发脑动脉瘤,共检出115个。余14例因诊断不明确进而实施DSA脑血管造影检查,其中确诊动脉瘤合并烟雾病2例、严重脑血管痉挛致动脉瘤显示不清2例、脑动静脉畸形1例(此5例与3D-CTA所见一致);在3D-CTA扫查范围外发现脑动脉瘤2例。对上述阳性诊断的99例进行手术,并得到证实。另7例在3D-CTA和DSA检查未发现引起SAH的原因病灶,给予保守治疗。结论在脑动脉瘤诊断中,3D-CTA具有较好的精确性。在判断动脉瘤与颅骨位置关系、操作的便捷性和经济性等方面明显优于DSA。在应用3D-CTA对脑动脉瘤进行诊断时,有必要根据患者和设备的具体情况进行个性化设计,方能减少漏诊、误诊。
Objective To investigate the precautions of three-dimensional CT angiography (3D-CTA) in the diagnosis of cerebral aneurysm. Methods A total of 106 cases of subarachnoid hemorrhage (SAH) were retrospectively reviewed. Of the 14 cases, the first 3D-CTA showed aneurysm aneurysm or intracranial non-aneurysm-like vascular abnormalities. DSA cerebrovascular Contrast examination. Results The first 3D-CTA examination correctly diagnosed 92 cases of cerebral aneurysms, of which 16 cases were multiple cerebral aneurysms, a total of 115 were detected. In the remaining 14 cases, DSA cerebrovascular angiography was performed due to unclear diagnosis. Among them, 2 cases of aneurysm complicated with moyamoya disease, 2 cases of aneurysm showed serious cerebral vasospasm and 1 case of cerebral arteriovenous malformation were found -CTA consistent); 2 cases of cerebral aneurysm were found outside the scope of 3D-CTA scan. 99 cases of the above positive diagnosis were surgically confirmed. The other 7 cases were treated conservatively in 3D-CTA and DSA without finding the cause of SAH. Conclusion 3D-CTA has a good accuracy in the diagnosis of cerebral aneurysms. In determining the aneurysm and the skull position, the convenience and economy of operation is obviously better than the DSA. When using 3D-CTA for the diagnosis of cerebral aneurysms, it is necessary to personalize the design according to the patients and equipment to reduce the missed diagnosis and misdiagnosis.