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目的评价螺旋CT血管造影(SCTA)对脑血管痉挛(CV)检出的临床应用价值。方法急性蛛网膜下腔出血(SAH)患者12例,出血停止后5～10d行SCTA检查,最大密度投影(MIP)及表面遮盖法(SSD)三维成像后处理。数字减影血管造影(DSA)在SCTA后24h内进行。观察测量6个脑动脉位置:颈内动脉鞍上段、大脑中动脉M1、M2段,大脑前动脉A1、A2段及基底动脉的直径。根据管腔直径将脑血管分为无狭窄、轻度狭窄(管腔缩小<30%)、中度狭窄(管腔缩小30%～50%)、重度狭窄(管腔缩小>50%)。比较SCTA与DSA对CV的检出情况。结果SCTA与DSA对CV检出相关因子为0.78,但对近端血管相关性好过远端血管(0.83～1.00:0.18～0.54)。对无狭窄(91%)及严重狭窄(100%)的检出与DSA的相关程度高,对轻度狭窄(56%)及中度狭窄(75%)相关程度差。结论SCTA对近端血管无狭窄或者严重狭窄诊断准确性高,对远端血管轻度狭窄的诊断准确性较差。
Objective To evaluate the clinical value of spiral CT angiography (SCTA) in detecting cerebral vasospasm (CV). Methods Twelve patients with acute subarachnoid hemorrhage (SAH) were treated with SCTA, MIP and SSD after 5 to 10 days after the cessation of hemorrhage. Digital subtraction angiography (DSA) was performed within 24 hours after SCTA. Six cerebral arteries were observed and measured. They were the upper part of the internal carotid artery, the M1 and M2 segments of the middle cerebral artery, the segments A1 and A2 of the anterior cerebral artery and the diameter of the basilar artery. According to the lumen diameter, the cerebrovascular vessels were divided into no stenosis, mild stenosis (<30% lumen reduction), moderate stenosis (30% ~ 50% lumen constriction, and severe stenosis (50% lumen lumen). Compare the detection of CV by SCTA and DSA. Results The correlation coefficient of SCTA and DSA for CV was 0.78, but its correlation with proximal blood vessels was better than distal blood vessels (0.83-1.00: 0.18-0.54). The detection of no stenosis (91%) and severe stenosis (100%) was associated with a high degree of DSA and poorly correlated with mild stenosis (56%) and moderate stenosis (75%). Conclusion SCTA has high diagnostic accuracy for proximal stenosis or severe stenosis, and poor diagnostic accuracy for distal stenosis.