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目的 探讨多层面螺旋CT三维血管造影 ( 3D MSCTA)作为脑动脉瘤首选诊断方法的临床价值。方法 2 3例疑诊脑动脉瘤病例 (其中 13例有蛛网膜下腔出血 ) ,先后行 3D MSCTA、数字减影血管造影 (DSA)和手术治疗。Toshiba多层面螺旋CT AQUILION采集原始数据 ,扫描速度 0 5s/每转 ,层厚 1 0mm ,螺距 3 0 / 5 0mm ;对比剂安其格纳芬 :1 0～ 2 0ml/kg体重 ,注射速度 :2 5～ 3 0ml/s,延迟时间 :15～ 2 3s;SGIO2图像后处理工作站 ,后处理软件为 :ALATOVIEW版本 1 2 1;采用遮盖容积重建 (SVR)、最大密度投影 (MIP)和CT仿真内窥镜 (Fly through) 3种后处理技术。所得图像分别由 3位放射科医生和 2位脑外科医生评价。结果 3D MSCTA检出动脉瘤 2 5个 ,显示瘤体、瘤颈、载瘤动脉和与周围血管及颅骨的关系清晰、确切。DSA检出动脉瘤 2 2个 ,漏检 1个前交通动脉瘤和 2个左中动脉瘤。 2 3例病人中 16例接受手术治疗 ,3D MSCTA诊断与术后诊断一致。瘤体最大直径 14 0mm ,最小直径 1 7mm ,与DSA测量结果经t检验无显著性差异 (t=1 4 6,P >0 0 5 )。结论 3D MSCTA检出脑动脉瘤敏感性高、快速、无创 ,可以作为诊断脑动脉瘤的首选影像学方法。
Objective To investigate the clinical value of multi-slice spiral CT angiography (3D MSCTA) as the first choice of diagnosis of cerebral aneurysm. Twenty-three cases of suspected cerebral aneurysms (including 13 cases of subarachnoid hemorrhage) were treated with 3D MSCTA, DSA and surgery. Toshiba multi-slice spiral CT AQUILION acquisition of the original data, scanning speed 0 5s / per revolution, layer thickness 10mm, pitch 30/5 0mm; contrast agent and its agarfin: 10 ~ 20ml / kg body weight, 2 ~ 3 0ml / s, delay time: 15 ~ 2 3s; SGIO2 image post-processing workstation, post-processing software: ALATOVIEW version 1 2 1; using shadow volume reconstruction (SVR), maximum density projection (MIP) Endoscopic (Fly through) 3 kinds of post-processing technology. The resulting images were evaluated by three radiologists and two brain surgeons respectively. Results 3D MSCTA detected 25 aneurysms, showing a clear and exact relationship between the tumor, tumor neck, parent artery, and the surrounding blood vessels and skull. DSA detected 2 of aneurysms, missed anterior communicating artery aneurysm and 2 left middle aneurysm. Twenty-six of the 23 patients underwent surgery, and the 3D MSCTA diagnosis was consistent with the postoperative diagnosis. The maximum diameter of the tumor was 14 0 mm and the minimum diameter was 17 mm. There was no significant difference (t = 146, P> 0.05) with the DSA measurement by t-test. Conclusion The detection of cerebral aneurysms by 3D MSCTA is sensitive, rapid and noninvasive and can be used as the imaging method of choice for the diagnosis of cerebral aneurysms.