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目的探讨旋转式数字减影血管造影三维重建成像(3D-DSA)在诊断和治疗颅内动脉瘤中的价值。方法选择217例蛛网膜下腔出血患者,行常规DSA及3D-DSA检查。比较二者在显示动脉瘤的位置、大小、形态、瘤颈的宽窄及与载瘤动脉的空间关系中的作用。对证实为颅内动脉瘤的患者行介入栓塞或开颅夹闭术,应用3D-DSA对术后部分患者评价诊治效果。结果常规DSA发现139例(64.1%)153个动脉瘤;3D-DSA检出156例(71.9%)177个动脉瘤(检出率提高7.8%,P<0.01),其中有常规DSA漏诊的、直径<2mm的微小动脉瘤3个,发现5例常规DSA呈假阳性的患者;3D-DSA在显示动脉瘤瘤颈、瘤体形态及与载瘤动脉的空间关系方面明显优于常规DSA,差异有统计学意义(P<0.01)。弹簧圈栓塞97例,夹闭52例,保守治疗7例;应用3D-DSA随访术后84例介入栓塞和45例开颅夹闭患者,效果良好。结论3D-DSA技术显著提高动脉瘤检出率,能多角度立体显示动脉瘤大小、形态、瘤颈的宽窄及与载瘤动脉的空间关系,为治疗和评价诊治效果提供精确丰富的数据信息。
Objective To investigate the value of rotational digital subtraction angiography (3D-DSA) in the diagnosis and treatment of intracranial aneurysms. Methods 217 patients with subarachnoid hemorrhage were selected for routine DSA and 3D-DSA. Compare the two in the aneurysm shows the location, size, shape, tumor neck width and the relationship between the parent artery and the role of space. The patients confirmed by intracranial aneurysm were treated with embolization or craniotomy occlusion. 3D-DSA was used to evaluate the diagnosis and treatment effect in some patients after operation. Results A total of 139 aneurysms were found in 139 patients (64.1%) by conventional DSA. A total of 177 aneurysms were detected in 156 patients (71.9%) by 3D-DSA. The detection rate was 7.8% (P <0.01) There were 3 small aneurysms with diameter <2mm, and 5 patients were found to have false positive DSA. 3D-DSA was superior to conventional DSA in displaying the aneurysm neck and tumor morphology and the spatial relationship with tumor-bearing artery. There was statistical significance (P <0.01). There were 97 cases of coil embolization, 52 cases of clipping and conservative treatment in 7 cases. 84 cases were involved in embolization and 45 cases of craniotomy occlusion after 3D-DSA follow-up. Conclusion The 3D-DSA technique can significantly improve the detection rate of aneurysms, and can display the aneurysm size, shape, tumor neck width and spatial relationship with the parent artery artificially from multiple angles, and provide accurate and rich data for the treatment and evaluation of diagnosis and treatment effect.