157例颅内动脉瘤患者CT血管成像与DSA临床分析

目的:探讨CT血管成像(CTA)在临床诊断颅内动脉瘤的价值。方法:回顾性分析本院157例经影像学检查或手术后确诊为颅内动脉瘤的患者,所有病例均依次行头颅CTA及DSA检查,由A、B两组医生(各三名),对CTA及DSA检查的结果进行独立的双盲判读确定,评估CTA和DSA对颅内动脉瘤诊断的敏感性,特异性;在CTA及DSA图像上分别测得瘤体最长径,比较两种检查在瘤体最长径测量上的结果差异;对颅内微动脉瘤(瘤体直径D3 mm)检出的敏感性比较。结果:1头颅CTA检出148例(94%),假阴性9例,DSA检出151例(96%),假阴性6例,两者特异性比较,无显著差异(P0.05)。2在CTA图像上测得瘤体最长径均数D=5.495 mm,在DSA图像上测得瘤体最长径均数D=5.503 mm,两种测量的测量值之间比较,无显著差异(P0.05)。3在微动脉瘤敏感性上,157例患者共有37个微动脉瘤,CTA检出35个,DSA检出33个,两种检查方法比较,无显著差异(P0.05)。结论:头颅CTA和DSA在颅内动脉瘤的诊断上具有相同的敏感性和特异性,可作为颅内动脉瘤的首选筛查。     

三维DSA在颅内动脉瘤中的应用

目的探讨三维数字减影血管造影(3D DSA)在颅内动脉瘤中的应用价值。方法使用GE Innova 3100平板血管造影机对40例疑似颅内动脉瘤患者行双侧颈内、外动脉和双侧椎动脉正、侧位2D DSA,进一步对感兴趣血管行3D DSA,通过容积再现(VR)进行颅内血管重建。结果 3D DSA检出39例动脉瘤患者,47枚动脉瘤,2D DSA检出31例动脉瘤患者,35枚动脉瘤,二者检出动脉瘤的长、短径无统计学差异(P>0.05),图像质量有统计学差异(P<0.05)。2D DSA出现假阳性动脉瘤3枚,假阴性动脉瘤15枚,评估颅内动脉瘤的灵敏度为78.9%,特异性为85.2%;3D DSA没有出现假阳性、假阴性动脉瘤,评估颅内动脉瘤的灵敏度为100%,特异性为100%。在动脉瘤形态、瘤颈尺寸及与相邻血管间的关系的显示上,3D DSA明显优于2D DSA。结论 3D DSA作为脑动脉造影中2D DSA的进一步补充,对颅内动脉瘤的诊断与治疗具有重要价值。     

16层螺旋CT血管成像诊断颅内动脉瘤的价值

目的:探讨16层螺旋CT血管成像(16SCTA)诊断颅内动脉瘤的价值.方法:对33例16SCTA诊断的颅内动脉瘤进行回顾性分析.其中4例经手术证实,13例经数字减影血管造影(DSA)证实.结果:16SCTA在33例患者中,共发现40个动脉瘤.其中3例为两个动脉瘤,2例为三个动脉瘤.40个动脉瘤中大脑中动脉瘤9个,大脑前动脉瘤8个,大脑后动脉瘤2个,后交通动脉瘤4个,颈内动脉瘤12个,基底动脉瘤3个,胼周动脉瘤1个,小脑上动脉瘤1个.16SCTA均清晰显示瘤体的大小、位置、形态及瘤颈宽度、瘤轴指向、载瘤动脉、动脉瘤与周围重要解剖结构的关系.有DSA资料对照的13例中,16SCTA发现16个动脉瘤中DSA只发现13个,另外DSA发现1个动脉瘤而16SCTA漏诊.16SCTA诊断颅内动脉瘤的敏感度、特异度、阳性预测值、阴性预测值分别为92.9%、97.1%、81.3%、99%.结论:16SCTA在颅内动脉瘤临床诊断和术后随访中有较高的应用价值.     

头颅电子计算机断层扫描血管造影和头颅磁共振血管成像在颅内动脉瘤中诊断价值比较的回顾性研究

摘要 目的：研究对比头颅电子计算机断层扫描血管造影（CTA）和头颅磁共振血管成像（MRA）在颅内动脉瘤中诊断价值。方法：回顾性分析医院2019年1月2日～2020年12月15日收治的60例疑似颅内动脉瘤患者资料,所有受试者均开展头颅CTA检查、MRA检查以及数字减影血管造影（DSA）检查。以DSA检查结果为金标准,比较头颅CTA和头颅MRA诊断颅内动脉瘤的效能。此外,对比头颅CTA和头颅MRA诊断不同分级、不同部位颅内动脉瘤的符合率。结果：DAS检查结果显示确诊动脉瘤患者48例,共检出动脉瘤74个,CTA检出动脉瘤65个,MRA检出动脉瘤51个,CTA动脉瘤检出率高于MRA检出率（均P＜0.05）。以DSA结果为金标准,CTA诊断颅内动脉瘤的灵敏度、特异度以及准确度分别为94.20%（65/69）、60.00%（3/5）、91.89%（68/74）,均高于MRA的82.26%（51/62）、41.67%（5/12）、75.68%（56/74）（均P＜0.05）。CTA诊断1级颅内动脉瘤的符合率为13.85%（9/65）,高于MRA的7.84%（4/51）（P＜0.05）。各种检查方式诊断不同部位颅内动脉瘤的符合率对比均无明显差异（均P＞0.05）。结论：CTA诊断颅内动脉瘤的灵敏度、特异度以及准确度均高于MRA,可提高对小直径肿瘤的检出率。然而,MRA具有无辐射、检测费用少、安全性高等优势,临床实际工作中可综合选择合理的检查方式。     

64层螺旋CT血管成像诊断胚胎型大脑后动脉及与DSA诊断的比较研究

目的:探讨64层螺旋CT血管成像(CTA)诊断胚胎型大脑后动脉(FTF)的准确性及其临床价值.方法:回顾性分析62例同时做了64层螺旋CTA和DSA脑血管检查患者的影像学资料,将CTA诊断FTP的结果与DSA检查结果进行比较,分析CTA诊断FTP的准确性.结果:62例中,DSA诊断FTP10例,CTA诊断FTP13例,CTA诊断FTP的敏感性为100%,特异性为96.40%,准确性为96.77%.经Kappa一致性检验,CTA与DSA诊断FTA的结果高度一致(P<0.001).结论:64层螺旋CTA能够无创性准确判断FTP的存在,对筛选FTP患者具有重要意义,能为脑血管疾病的诊断与治疗提供重要信息.     

三维CT血管造影在颅内动脉瘤夹闭术后复查中的应用

目的:评价三维CT血管造影(3D-CTA)在颅内动脉瘤夹闭术后复查中的应用价值.方法:选取我院神经外科2010年8月至2012年1月间,共42例颅内动脉瘤夹闭术后患者(45个动脉瘤),分别于动脉瘤夹闭术后5-7天,5-6个月,12个月接受三维CT血管造影(3D-CTA)和数字减影血管造影(DSA)检查,以DSA为金标准,判断CTA对动脉瘤术后残留、血管闭塞狭窄等检出的灵敏度和特异度.结果:3D-CTA发现4例瘤颈残留,1例吻合血管闭塞,28例载瘤动脉通畅,6例术中阻断的载瘤动脉不显影,61个动脉瘤夹均可清晰辨识,与DSA结果一致.3D-CTA评价瘤颈残留与载瘤动脉、吻合血管通畅的灵敏度和特异度均为100％,一致性为1.0.结论:3D-CTA检查操作简便,结果真实可靠,临床应用价值极高,能够很好的显示动脉瘤夹闭术后改变,可作为颅内动脉瘤夹闭术后长期多次随访的主要方法.     

血管超声与64排螺旋CT血管造影在评价颈动脉狭窄中的对比研究

目的:比较血管超声与64排螺旋CT血管造影(CTA)对颈动脉狭窄的诊断价值。方法:选取2014年12月到2015年12月我院收治的疑似颈动脉狭窄患者70例(278节段),所有患者入院1周内均行血管超声、64排螺旋CTA检查,以数字减影血管造影(DSA)为金标准,比较血管超声与64排螺旋CTA对颈动脉狭窄诊断的符合率、特异度和灵敏度。结果:血管超声和64排螺旋CTA对不同程度颈动脉狭窄诊断的符合率比较,差异均无统计学意义(P0.05);血管超声和64排螺旋CTA对颈动脉狭窄诊断的灵敏度和特异度分别为87.28%、85.71%和85.55%、90.48%,比较差异无统计学意义(P0.05)。结论:血管超声和64排螺旋CTA对颈动脉狭窄均具有较高的诊断价值。     

冠状动脉CTA和DSA对冠心病患者的临床诊断价值比较

目的:比较冠状动脉CT血管成像(CT angiography,CTA)以及数字减影血管造影(digital subtraction angiography,DSA)诊断冠心病的临床价值差异。方法:选择2013年12月至2020年3月安徽医科大学第三附属医院、安徽医科大学第四附属医院收治的60例冠心病患者为研究对象,首先对其实施多排螺旋CT冠状动脉血管造影检测(CTA),而后2 w内再对其实施DSA检测,比较两种检测方式对不同血管狭窄程度、不同性质斑块检出率的差异,最后以DSA检测结果为金标准,评估CTA对冠状动脉狭窄诊断的一致性、灵敏度、特异度、阳性预测值和阴性预测值。结果:(1)CTA检测狭窄血管共计387支,轻度狭窄152支(39.28%),中度狭窄118支(30.49%),重度狭窄105支(27.13%),闭塞12支(3.10%);DSA检测狭窄血管392支,轻度狭窄150支(38.27%),中度狭窄124支(31.63%),重度狭窄112支(28.57%),闭塞6支(1.53%),两组各血管狭窄类型比较差异无统计学意义(P0.05);(2)CTA检测斑块69个,其中钙化斑43个(62.32%),非钙化斑26个(37.68%),DSA检测斑块61个,其中钙化斑33个(54.10%),非钙化斑28个(45.50%),两种检测方式差异无统计学意义(P0.05);(3)以DSA检测为金标准,CTA对重度及以上血管狭窄诊断一致性为99.23%,特异度为98.31%,灵敏度为99.64%,阳性预测值为99.15%,阴性预测值为99.27%。结论:与DSA相比,CTA对冠心病患者血管狭窄的诊断价值相当,且属于无创检测,在冠心病早期筛查中临床应用价值更高。     

数字减影CTA诊断破裂颅内动脉瘤和预测动脉瘤破裂的价值

目的:评价数字减影CTA诊断破裂颅内动脉瘤和预测动脉瘤破裂效用。方法:对72例后期确诊为动脉瘤破裂引起的蛛网膜下腔出血患者行数字减影CTA(DSCTA)、数字减影血管成像(Digital subtraction angiography,DSA),对比多发动脉瘤患者破裂动脉瘤、未破裂动脉瘤DSCTA参数。结果:DSCTA发现动脉瘤86个,DSA检查发现89个;15例患者多发动脉瘤,破裂动脉瘤L、AR、SR均高于未破裂者,有子囊者L、AR、SR均高于无子囊者,差异具有统计学意义(P0.05)。结论:DSCTA可诊断绝大多数破裂动脉瘤、未破裂动脉瘤检出率较高,对比相关参数可初步预测破裂风险,但DSCTA、DSA使用均有一定风险,且诊断效用受患者、医师技术水平、病理因素影响,医师应积极总结应用经验。     

多层螺旋CT 血管造影在脑动脉瘤中应用

目的:观察多层螺旋CT血管造影对脑动脉瘤的诊断价值.方法:对16例脑动脉瘤患者的多层螺旋CT血管造影结果进行总结分析.结果:多层螺旋CT血管造影的诊断准确性与DSA无明显差异;多层螺旋CT血管造影显示动脉瘤的部位、大小、动脉瘤颈结构及其与周围血管的关系等与手术结果基本符合.结论:多层螺旋CT血管造影对脑动脉瘤的诊断准确率高,具备十分重要的临床应用价值.     

血管内介入治疗颅内动脉瘤合并缺血性脑血管疾病的临床研究

摘要 目的：探讨血管内介入治疗颅内动脉瘤（IA）合并缺血性脑血管疾病的安全性和有效性。方法：回顾性分析了2018年1月至2020年12月使用血管内介入治疗IA合并缺血性脑血管疾病的32例临床资料。结果：32例中共发现了35枚IA,37处狭窄。IA平均大小为（5.17±3.12）mm,其中位于颈内动脉有26枚（74%）,位于椎基底动脉有9枚（26%）,7例（22%）患者术前检查发现存在两枚IA。37处狭窄中,位于椎基底动脉有9处（24%）,位于颅外段有8处（22%）,其余20处狭窄（54%）均位于颈内动脉,术前平均狭窄率为75.7%。所有病例手术过程顺利,术后IA中达到完全栓塞有31枚（89%）,4枚残留颈部（11%）。37处狭窄中,术后平均狭窄率为8.8%,所有患者术后造影脑血管远端均通畅。治疗期间1例支架内再狭窄,1例脑血管痉挛,出院时所有病例改良Rankin评分量表（mRS）均小于2分。32位患者均得到术后全脑血管造影（DSA）随访,随访时间为6到18个月（平均为8.8个月）,随访期间1例出现支架内再狭窄。结论：血管内介入治疗IA合并缺血性脑血管疾病是安全有效的,值得临床借鉴应用。     

介入栓塞治疗内脏动脉瘤的临床研究

目的:探讨介入血管腔内栓塞治疗内脏动脉瘤的方法、疗效及安全性。方法:选择内脏动脉瘤患者23例,包括脾动脉瘤13例,肝动脉瘤2例,胃十二指肠动脉瘤3例,肠系膜上动脉瘤4例,肾动脉瘤1例。其中,9例行远近端动脉栓塞术,4例采用支架辅助弹簧圈瘤体内填塞,3例采用弹簧圈瘤体内填塞加瘤体内注胶栓塞术,4例行弹簧圈瘤体内栓塞术,2例行分支动脉颗粒栓塞术,1例行单纯注胶栓塞术。术后1月、3月、6月行超声、CTA或血管造影复查,以后每年复查一次。结果:本组均成功行介入血管腔内栓塞治疗内脏动脉瘤,栓塞治疗后造影示动脉瘤体和/或载瘤动脉闭塞,动脉瘤体内无明显对比剂显影,脾动脉瘤栓塞患者有3例出现发热,脾区疼痛等脾梗塞症状,未见栓塞术相关严重并发症发生。4例消化道出血患者出血均停止。术后随访3~48个月,未见动脉瘤破裂出血、动脉瘤复发或增大,支架置入者,支架内及分支动脉血流均保持通畅。结论:介入血管腔内栓塞是一种治疗内脏动脉瘤的简便、微创、安全有效的方法。     

Clinical Study of the Role of 64-Slice CT Cerebra Angiography in Aneurysmal Subarachnoid Hemorrhage

The objective of this study is to assess the clinical role of computed tomography angiography (CTA) in determining the etiology of aneurysmal subarachnoid hemorrhage (ASAH) and selecting the treatment options. A total of 452 patients with ASAH underwent a 64-slice CTA examination to determine the etiology and select the treatment strategies. Digital subtraction angiography (DSA) or clipping operation confirmed the detection from the CTA. The CTA results of 452 patients with ASAH were confirmed through the DSA or clipping operation and the CTA results of 451 cases were consistent with what were seen during the DSA or clipping operation. The treatment choices for 451 patients (99.8 %) were based on the CTA results. A total of 90 cases (19.9 %) underwent endovascular embolization and 362 cases (80.1 %) underwent clipping operation. The other one patient underwent endovascular embolization after the DSA examination due to insufficient information from the CTA. Also, there was one patient who was misdiagnosed in the CTA. In conclusion, a 64-slice CTA can accurately detect intracranial aneurysms and is helpful in choosing the best treatment option.     

Abdominal aortic aneurysms: recent experience with 210 patients.

In the 6 1/2 years ending June 1977, 210 patients with abdominal aortic aneurysms underwent operation at Toronto Western Hospital; 160 aneurysms (76%) were unruptured and 50 (24%) were ruptured. In the patients with unruptured aneurysms the mean age was 68 years; the oldest was 91, and 12 were more than 80 years of age. The overall hospital mortality was 5.6%. Death in hospital occurred in 1 (1.2%) of the 83 asymptomatic patients, 4 (7.4%) of the 54 symptomatic patients and 4 (17.0%) of the 23 patients for whom operation was considered urgent. In the patients with ruptured aneurysms the mean age was 71 years; the oldest was 90, and five were more than 80 years of age. The overall hospital mortality was 54%. The morbidity and mortality were analysed; in particular the reasons for the markedly variable hazard of operations for the three categories of unruptured aneurysm were sought. The surgical literature is confusing because of the interchanging use of the words unruptured, elective and symptomless. The current philosophy management and technique of operation in a large cardiovascular surgery service with many trainees are presented and a plea is made for a standardized and simplified operation, always performed with three assistants helping the operating surgeon.     

小脑后下动脉瘤经微血管多普勒超声辅助下的显微外科治疗

目的：探讨小脑后下动脉瘤（PICA）的微血管多普勒超声（MVD）辅助下显微外科治疗。方法：回顾性分析31例患者的显微外科手术的临床症状,影像特点,外科治疗方法及相关预后。结果：头颅CT表现主要为幕下为主的蛛网膜下腔出血或脑室出血或二者兼有（除1例未破裂）。其中经全脑数控减影血管造影术（DSA）和/或CT血管造影（CTA）检查确诊。其中手术路径为枕下旁正中16例,枕下正中入路14例,枕下乙状窦后入路1例。在MVD的辅助下行脉瘤夹闭术27例,动脉瘤包裹术1例,动脉瘤夹闭并动静脉畸形切除术2例,动脉瘤夹闭术并小脑血肿清除术1例。术后出现并发症10例,其中3例意识障碍致死亡或自动出院,其余患者术后无神经功能损伤或并发症,恢复良好。结论：小脑后下动脉瘤的治疗选择合适的手术入路行显微外科手术,辅助MVD下,能够降低手术风险,提高完全夹闭动脉瘤的成功率,降低手术并发症的发生。     

Value of DSA in the Diagnostic Workup of Pulsatile Tinnitus

ObjectivesPulsatile tinnitus (PT) is a rare complaint, but can be a symptom of life-threatening disease. It is often caused by vascular pathologies, e.g. dural arteriovenous fistula (dAVF), arteriovenous malformation (AVM) or vascularized tumors. The current diagnostic pathway includes clinical examination, cranial MRI and additional DSA. The aim of this study was to evaluate the diagnostic impact of DSA in the diagnostic workup of patients with PT in comparison to MRI alone.MethodsRetrospectively, 54 consecutive patients with pulsatile tinnitus were evaluated. All patients had a diagnostic workup including cranial MRI and DSA. MRI examinations were blinded to the results of DSA and retrospectively analyzed in consensus by two experienced neuroradiologists. The MR-examinations were evaluated for each performed sequence separately: time-of-flight-angiography, ce-MRA, T2, ce-T1-sequence and ce-T1-sequence with fat saturation.Results37 of the 54 patients revealed a pathology explaining PT on MRI, which was detected by the readers in 100% and proofed by means of DSA. 24 dAVF, four paraganglioma, two AVM and seven more pathologies were described. All patients without pathology on MRI did also not show any pathology in DSA.ConclusionsMR imaging is sufficient to exclude pathology in patients with pulsatile tinnitus.     

肠系膜上动脉栓塞临床表现及影像特征研究

目的:探讨肠系膜上动脉栓塞(superior mesenteric artery embolism,SMA embolism)临床及影像特征,以及时准确诊断从而改善病人预后。方法:搜集我院2011年7月至2014年8月临床诊断为SMA栓塞的患者24例,回顾性分析其临床及影像资料。结果:24例SMA栓塞发病年龄51~84岁,平均71.9±8.1岁;临床均表现为突发腹痛(24/24,100%),腹痛多持续不缓解(18/24,75%),少有放射痛(1/24,4.17%),多伴有恶心呕吐(16/24,66.67%)、腹泻便血(15/24,62.5%),体格检查多有肠鸣音亢进(19/24,79.17%),少有腹膜刺激征(2/24,8.33%)。多合并高血压(18/24,75%)、房颤(16/24,66.67%)、冠心病(14/24,58.33%)、心脏瓣膜病变(6/24,25%)及其他周围动脉栓塞(9/24,37.5%)。临床上符合SMA栓塞三联征中至少两项特征20例(83.33%),具备典型三联征13例(54.17%)。MSCTA或DSA均表现为SMA主干截断或充盈缺损(24/24,100%),栓塞位置多位于第1空肠动脉起始至回结肠动脉起始水平段(18/24,75%),栓塞远端分支血管多显影不良(23/24,95.83%),少有侧枝循环形成(3/24,12.5%)。MSCTA显示栓塞段血管密度多有增高(12/17,70.59%),少有管径增粗(3/17,17.65%)及脂肪间隙模糊(2/17,11.76%)。肠管多有缺血改变(15/17,88.24%),肠系膜多增粗模糊(15/17,88.24%),腹水少见(1/17,5.82%)。结论:SMA栓塞临床和影像具有一定的特征性,临床怀疑SMA栓塞应及早行MSCTA或DSA明确诊断。     

The use of digital subtraction angiography in diseases of the arteries of the pelvis and lower limbs

The diagnostic potentialities of digital subtraction angiography (DSA) in diseases of the pelvic arteries and lower limbs were studied. Intravenous (iv) and intraarterial (ia) DSA were performed in 613 patients, among them were patients with obliterating atherosclerosis and endarteritis, thromboembolism, aneurysms and arteriovenous fistulas. Iv DSA provided good information for the solution of therapeutic and tactical problems in pelvic, femoral and popliteal arterial lesions but in 16% of the cases it gave no opportunity to assess the status of the crural arteries. Ia DSA was shown to be no inferior to routine arteriography in the visualization of the lower limb arteries. This method is economical, well tolerated by patients, permits the intensification of examination of patients with acute and chronic arterial pathology. It can be employed under outpatient conditions and in the early postoperative period.