【www.zhangdahai.com--安全生产公文】
【摘要】 目的 探讨多排螺旋CT(MSCT) 数字减影血管造影术在颅内微小动脉瘤诊断中的临床应用价值。 方法 回顾分析本院31例可疑颅内微小动脉瘤患者,应用MSCT数字血管造影术(简称减影CTA)进行颅内动脉成像检查,全部患者均进行了手术确诊或DSA检查,并将两种检查结果进行比较。 结果 全部患者中手术及DSA造影共检出微小动脉瘤35个,采用数字减影CTA共检出32个,敏感性为91.4%。结论 MSCT数字减影血管造影术是一种安全、无创的新型检查方法,具有较高的特异性及敏感性,在颅内微小动脉瘤的初步筛选及评价方面具有较高的临床应用价值。
【关键词】 微小动脉瘤; CT数字减影; X线计算机
Clinical Application Digital Subtract CTA in intracranial micro-small aneurysm
WANG zongsheng 1 ZHOU xia2 ZHOU Shengli,.1
(1、Department of Radiology, First People’s Hospital of Lianyungang, 2、The Endocrine Section of Internal Medicial Dept. Lianyungang,222002,China)
【Abstract】 Objective :To study the value of the application of MSCT digital subtraction CT angiography(DSCTA)in the diagnosis of intracranial micro-small aneurysm. Method MSCT digital subtract angiography were undertaken in 31 patients who were suspected to have intracranial micro-small aneurym . Digital subtract angiography was also undertaken in all the patients. All the patients were treated by surgical operation. Results: By operation and DSA 35 cases of micro-small aneurysms were founded, By DSCTA,32cases of aneurysms were found, The sensitivity and specificity of subtract CTA was 91.4%. Conclusion MSCT subtract CTA is a new techuich, which is safe and has no injury. It has high specificity and sensitivity in the diagnosis of the micro-small aneurysm It has high clinical value in the preliminary csreening of micro-smal aneurysm and evaluation.
【Key words】 Micro-small aneurysm . CT digital subtract angiography . X-ray computer
随着医学影像技术的飞速发展,多排螺旋CT血管造影检查(CTA)技术已逐步替代数字减影全脑血管造影(DSA)成为颅内动脉瘤诊断的首选检查方法[1-3],颅内微小动脉瘤(最大直径 3.2 数字减影CTA技术在颅内微小动脉瘤诊断中的注意事项
我们做了改进的数字减影CTA技术包括:①因为检查患者不能移动,否则减影效果不良,影响结果判断,我们采用头部固定托架等多种方法严格保证两次扫描位置完全一致;②由于减影图像的成像质量取决于对比剂到达靶血管的浓度,一般要求CT值差异在100 Hu以上;我们采用适当提高造影剂浓度(一般350mg/ml)和加快注射速度(4 ml/s)等方法来保证对比剂增强效果;③采用对比剂自动跟踪技术,单独测定每位患者的延迟时间,尽量避免海绵窦等颅内静脉显影,影响减影效果和微小动脉瘤的检出;④扫描时间采取球管转数整数倍,确保减影效果;⑤采集图像数据后,采用多平面(曲面)重建(MPR、CPR )、最大密度投影(MIP)、容积重建(VR)、仿真内镜(CTVE)等多种技术,从多平面、多角度观察,排除病变,进行后处理。⑥由于微小动脉瘤直径通常小于5mm,对空间分辨率要求较高,CT扫描采集数据时必须使用0.625mm最小层厚及50%重叠率。取得了满意效果。
综上所述,MSCT数字减影CTA技术是一种安全、无创的新型检查方法,可以精确地描述颅内微小动脉瘤的病理状态,在颅内动脉瘤的诊断方面具有较高的特异性及敏感性,可以精确描述动脉瘤的病理状态,对治疗方案的选择提供更为详细的影像信息,在颅内微小动脉瘤的初步筛选及评价方面具有较高的临床应用价值。
参考文献
[1] Chappell ET,Moure FC,Good MC. Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms:a meta-analysis[J]. Neurosurgery,2003,52(3):624-631.
[2] Pechlivanis I, Schmieder K ,Scholz M, et al. 3-Dimensional computed tomographic angiography for use of surgery planning in patient intracranial aneurysms [J]. Acta Neurochir (Wien),2005,147(10):1045-1053.
[3] Komotar RJ,Mocco J,Solomon RA.Guidelines for the surgical treatment of unruptured intracranial aneurysms:the first annual J,Lawrence pool memorial research sym posium--controversies in the management of cerebral aneurysms[J].Neurosurgery,2008,62(1):183―194.
[4] 谭继善,王淑慧,蒋敏,等. CTA 减影在颅内动脉瘤诊断中的应用价值[J]医学影像学杂志2006 ,16(5):443-445.
[5] ChowLC,RubinGD. CT AngiograPhy of the Arteria system〔J〕.Radiol Clin North Am,2002,40(4):729一749.
作者简介:
王宗盛,男,(1975 - ),江苏省连云港人,毕业于江苏大学医学院,学士学位,主治医师,主要从事影像诊断工作