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目的探讨三维CT血管造影术(3D-CTA)在急性蛛网膜下腔出血(SAH)颅内动脉瘤诊断中的应用。方法采用3D-CTA和DSA对26例非外伤性SAH患者进行检查,3D-CTA通过最大密度投影(MIP)、表面遮盖法重建(SSD)和容积重建术(VRT)方法获得图像,根据3D-CTA和DSA所获得的关于动脉瘤的位置、大小等进行术前评估。结果在26例中24例3D-CTA检测出27个动脉瘤,瘤体直径3～21 mm,1例后交通动脉瘤3D-CTA不能证实,1例未检出动脉瘤;14例行DSA检查,其中1例未检出动脉瘤而通过3D-CTA发现,1例右椎动脉梭形动脉瘤因DSA行右椎动脉造影失败而通过3D-CTA发现。12例仅凭3D-CTA手术,3D-CTA在检查动脉瘤的位置、大小、瘤体方向及对载瘤动脉和分支动脉的形态描述均优于DSA,它在诊断颅内动脉瘤的敏感性和特异性分别为96%和100%。结论3D-CTA是一种准确、价廉、非侵袭性的诊断颅内动脉瘤SAH的方法,在动脉瘤的急诊手术时较DSA更具优越性。
Objective To investigate the application of three dimensional CT angiography (3D-CTA) in the diagnosis of intracranial aneurysm of acute subarachnoid hemorrhage (SAH). Methods Twenty-six patients with non-traumatic SAH were examined by 3D-CTA and DSA. 3D-CTA images were obtained by maximum density projection (MIP), surface occlusion reconstruction (SSD) and volume reconstruction (VRT) CTA and DSA obtained on the aneurysm location, size, etc. for preoperative assessment. Results Twenty-seven aneurysms were detected in 24 cases of 3D-CTA in 26 cases. The diameter of the tumor was 3-21 mm. One case of post-operative aneurysm could not be confirmed by 3D-CTA. One case had no aneurysm detected. 14 cases underwent DSA , Of which 1 did not detect aneurysms and found by 3D-CTA, 1 case of right vertebral artery fusiform aneurysm due to DSA line of right vertebral artery angiography failed by 3D-CTA found. 3D-CTA was superior to DSA in the location, size, tumor direction of the aneurysms and morphologic description of the parent artery and branch artery in 3D-CTA alone in 12 cases. 3D-CTA was superior in diagnosing the sensitivity of intracranial aneurysms And specificity of 96% and 100%, respectively. Conclusion 3D-CTA is an accurate, inexpensive and noninvasive method to diagnose intracranial aneurysmal SAH. It is superior to DSA in the emergency surgery of aneurysms.