多层螺旋CT血管造影在成人出血型烟雾病诊断中的应用_临床医学论文.docVIP

多层螺旋CT血管造影在成人出血型烟雾病诊断中的应用_临床医学论文 多层螺旋CT血管造影在成人出血型烟雾病诊断中的应用_临床医学论文 作者：靳仓正 朱明欣 张应和 梁文钊 李春芳 陈秋艳 【摘要】 目的 探讨多层螺旋CT血管造影对成人出血型烟雾病的诊断价值。 方法 对19例成人出血型烟雾病患者常规平扫后，采用螺旋CT容积扫描模式行增强扫描，然后在工作站上分别采用最大密度投影、多平面重组、容积再现、“血管生长”技术容积再现进行血管重建。其中5例完成MSCTA后行DSA检查。 结果 19例患者CT平扫均显示不同部位脑出血，部分伴有脑萎缩或脑梗塞。MSCTA均清晰显示不同程度颈内动脉虹吸段、大脑前动脉及大脑中动脉起始段狭窄、闭塞，双侧病变者13例（68.4%），单侧病变者6例（31.6%）；脑底部见纤细迂曲的“烟雾”状异常血管网；大多可显示1支以上侧支动脉；1例显示右侧豆纹动脉囊状动脉瘤。5例同时行MSCTA与DSA者，均很好显示了上述血管病变。 结论 MSCTA可清晰显示成人出血型烟雾病异常血管，是诊断烟雾病的一种重要方法。 【关键词】 烟雾病；出血型；成人；多层螺旋CT；三维重建 [Abstract] Objective To explore the clinical value of multi-slice spiral CT angiography (MSCTA) in diagnosing hemorrhagic Moyamoya disease (MMD) in adults. Methods After non-contrast scan, enhancement scan by volume scan pattern of spiral CT was performed for 19 patients with hemorrhagic MMD, and then, blood vessel reconstruction was undertaken on work station, including maximum intensity projection (MIP), multiple planar reformation (MPR), volume rending (VR）and VR by“add vessel” technique. Five of them were performed digital subtraction angiography (DSA) after MSCTA. Results Non-contrast scan in all nineteen patients showed cerebral hemorrhage at different locations, some accomplished with cerebral atrophy or cerebral infarction. MSCTA showed stenosis and obstruction of internal carotid artery (ICA), anterior cerebral artery (ACA) and middle cerebral artery (MCA), including thirteen cases with bilateral and 6 cases with single lateral. There appeared abnormal vessels looked like smog on cerebral bottom. More than one branches of collateral artery could be seen in most of them. Sacculated aneurysm of lenticulostriate artery was shown in one patient. Five patients who were performed both MSCTA and DSA displayed similar above-mentioned vascular lesions. Conclusion MSCTA is an of important method to diagnose hemorrhagic MMD in adults for clearly showing the abnormal blood vessels. [Key words] Moyamoya disease; hemorrhagic; adult; multi-slice spiral computed tomography; three-dim