三维数字减影血管造影在颅内动脉瘤的诊断及动脉瘤夹闭术中的应用-影像医学与核医学专业论文.docxVIP

PAGE PAGE 1 中 文 摘 要 目的：探讨分析3D-DSA在颅内动脉瘤的诊断及动脉瘤夹闭术中的应用价值。 材料与方法：分析深圳市第二人民医院2011年1月～2013年1月期间102例行脑血管造影检 查及颅内动脉瘤夹闭术患者。其中58例行2D-DSA后再行3D-DSA检查，44例行2D-DSA检 查。所获得的2D-DSA及3D-DSA重建图像分别由两位有丰富阅片经验的介入科医师阅片并 得出统一诊断。对患者的临床资料进行回顾并结合有关文献进行对比分析，同组对比两种 不同影像检查对颅内动脉瘤的诊断价值，不同组对比2D-DSA和3D-DSA两组患者手术及术 后复查、随访情况。对于2D-DSA及3D-DSA的诊断及图像观察对比采用卡方检验分析，对 于两组患者的手术时间采用t检验分析，对于影响患者预后的因素采用卡方检验分析。 结果：3D-DSA组58例患者共发现73枚动脉瘤：49例为1枚动脉瘤，6例为2枚动脉瘤，1例 为3枚动脉瘤，2例为4枚动脉瘤；2D-DSA组44例患者53枚动脉瘤：37例为1枚动脉瘤，7例 为2枚动脉瘤，1例为3枚动脉瘤。1例在2D-DSA上诊断为动脉瘤，经3D-DSA证实为正常血 管返折、扩张；4例常规2D-DSA未发现动脉瘤，经3D-DSA诊断为4例4枚小动脉瘤。3D-DSA 对颅内动脉瘤的诊断率高于2D-DSA（P?0.05）；2D-DSA图像中能清楚显示动脉血管，无明 显伪影，在3D-DSA图像中有1例因配合欠佳出现严重伪影，影响图片质量，但2D-DSA图 像和3D-DSA图像的质量二者无统计学差别(P?0.05)；3D-DSA对于动脉瘤瘤颈的显示、动 脉瘤形态的显示、瘤颈和周围重要血管毗邻关系的评价明显优于2D-DSA(P?0.001)。 2D-DSA的血流动力学情况显示较好，能动态显示血管内和动脉瘤内的血流情况。使用 3D-DSA检查患者可减少动脉瘤夹闭术的手术时间，3D-DSA与2D-DSA检查患者术后恢复 无明显差异。 结论:应用3D-DSA可提高颅内动脉瘤的精确诊断率，进一步了解颅内动脉瘤夹闭术中动脉 瘤与临近血管的空间关系，指导手术治疗，减少动脉瘤夹闭术所用时间。 关键词：三维数字减影血管造影，颅内动脉瘤，动脉夹闭术，蛛网膜下腔出血。 汕头大学医学院研究生毕业论文 汕头大学医学院研究生毕业论文 Abstract Object: To evaluate the role of three-dimensional digital subtraction angiography in diagnosis and clipping of intracranial aneurysms. Methods: 102 Patients with intracranial aneurysms clipping were followed-up in the neurosurgical department of the Shenzhen second hospital from Jan. 2011 to Dec. 2012. 58 patients underwent 2D-DSA and 3D-DSA, 44 patients underwent 2D-DSA. Two Neuroradiology physician reading DSA images come out with unanimous opinion. The difference between 2D-DSA and 3D-DSA in diagnosis and image information was compared by Chi-Square test. The time of operation of the two groups analyzed by t-test. The difference of prognostic factors between two groups was compared by Chi-Square test. Results: 73 aneurysms were detected in 58 patients with 3D-DSA. 53 aneurysms were detected in 44 patients with 2D-DSA. The enlargement or backtracking of normal cerebral vessels was confirmed by 3D-DSA in 1 case, which was suspected to be aneurysm with 2D-DSA. 4 mini-aneurysms in 4 patients