CT血管成像评价颅内Willis环变异与前后交通动脉动脉瘤发生的关系

摘要

目的 探讨大脑前动脉水平段(A1段)发育异常和胚胎型大脑后动脉与颅内前、后交通动脉动脉瘤形成的关系. 方法 回顾性分析216例64排CT血管成像(CTA)的资料.①将216例中CTA发现有前后交通动脉动脉瘤的126例,分为前交通动脉动脉瘤(ACoAA)组69例和后交通动脉动脉瘤(PCoAA)组57例,其余CTA检查无动脉瘤,但有头痛、头晕的90例患者,作为对照组.②分析动脉瘤的有无,动脉瘤的部位、形态、大小和瘤颈的宽度、瘤顶指向及瘤体与周围结构的关系等.③将判定结果与手术结果进行对照.④同时观察大脑前动脉A1段是否存在发育不良或缺如,是否存在胚胎型大脑后动脉. 结果 ①64排CTA共检出前、后交通动脉动脉瘤126例,其中ACoAA 69例,PCoAA57例,以DSA和手术为判断标准,64排CTA检出动脉瘤的敏感性和特异性均为100％.②ACoAA组中一侧A1段发育不良或缺如达81.7％,明显高于PCoAA组和对照组(P ＜0.05)；PCoAA组中胚胎型大脑后动脉达56.1％,明显高于ACoAA组和对照组(P＜0.05).结论 (1)64排CTA检出动脉瘤具有较高的敏感性和特异性；②一侧大脑前动脉Al段发育不良或缺如及胚胎型大脑后动脉与前、后交通动脉动脉瘤的发生密切相关.%Objective To investigate the relationship between the dysplasia of horizontal segment ( A1 segment) of anterior cerebral artery and the formation of anterior and posterior communicating artery aneurysms. Methods The data of 64-slice computed tomography angiography (CTA) of 216 patients were analyzed retrospectively. Of the 216 patients, CTA found 126 patients with aneurysm. They were di-vided into anterior communicating artery aneurysm ( ACoAA) group (n =69) and posterior communicating artery aneurysm (PCoAA)group (re =57). The other patients without aneurysm revealed by CTA but with headache and dizziness (n =90) were used as a control group. The presence or absence of aneurysm,the location, shape, size and neck width of aneurysm, the apex pointing of aneurysm as well as the relationship between the aneurysmal bodies and surrounding structures were analyzed. The prejudged results and the surgical results were compared. Whether the anterior cerebral artery Al segment had dysplasia or not and whether it had fetal-type posterior cerebral artery or not were observed at the same time. Results ① A to-tal of 126 patients with communicating artery aneurysm were revealed by 64-slice CTA,among them 69 were ACoAA and 57 were PCoAA. Taking DSA and surgery as determining standards, the sensibility and speci-ficity detected by 64-slice CTA were 100%. ②Unilateral hypoplasia or absence of Al segment of anterior cerebral artery reached 81.1% in the ACoAA group, which was significantly higher than that in the PCoAA group or the control group (P < 0. 05); fetal-type posterior cerebral artery in the PCoAA group reached 56.1% , which was significantly higher than that in the ACoAA group or the control group (P < 0. 05 ). Conclusion 64-slice CTA has higher sensibility and specificity for detecting cerebral aneurysms. Unilat-eral hypoplasia or absence of Al segment of anterior cerebral artery and fetal-type posterior cerebral artery are closely associated with the occurrence of intracranial communicating artery aneurysms.