3D-DSA 在颅内微小动脉瘤诊断及指导治疗中的价值

摘要

目的：探讨3D‐DSA 在颅内微小动脉瘤诊断及指导治疗中的价值。方法对86例自发性蛛网膜下腔出血和脑动脉瘤可疑的患者行常规 DSA ，并行3D 重建，比较常规 DSA 与3D‐DSA 对颅内微小动脉瘤检出率的差异，同时基于3D‐DSA 显示动脉瘤情况指导临床选择最佳的治疗方式。结果常规 DSA 发现57例75个动脉瘤，其中直径≤5mm 动脉瘤39个，直径＞5mm 动脉瘤36个；3D‐DSA 发现69例86个动脉瘤，其中直径≤5mm 动脉瘤50个，直径＞5mm 动脉瘤36个，微小动脉瘤（直径≤5mm）检出率3D‐DSA 较常规 DSA 提高22％。依据3D‐DSA 显示动脉瘤的位置、瘤颈大小、瘤体与载瘤动脉关系，有40例患者分别选择手术或介入治疗，其中20例行动脉瘤夹闭术，13例行介入栓塞术，7例行支架辅助＋介入栓塞术。结论3D‐DSA 能明显提高颅内微小动脉瘤的检出率，在显示瘤颈大小、载瘤动脉和瘤体结构方面明显优于常规 DSA ，并有助于指导动脉瘤的治疗。%Objective To investigate the roles of 3D‐DSA in diagnosis and guiding treatment of intracranial small aneu‐rysms .Methods 86 cases of presumedly spontaneous subarachnoid hemorrhage and cerebral aneurysms patients under‐went conventional DSA examination ,and 3D‐DSA technology was applied .We compared the detection rate between con‐ventional DSA examination and 3D‐DSA examination in intracranial small aneurysm patients , simultaneously analyzed whether 3D‐DSA examination was more preferential for the presumed intracranial aneurysm patients .Results Conven‐tional DSA examination revealed 75 aneurysms among 57 cases ,including 39 casesm of the diameter of aneurysm ≤ 5 mm , 36 cases of the diameter > 5 mm in .3D‐DSA found 86 aneurysms in 69 cases ,aneurysms diameter equal or less than in 50 cases ,longer than 5 mm in 36 cases .Moreover ,the detection rate of small aneurysms (diameter ≤ 5 mm) by 3D‐DSA ex‐amination increased 22% compared with conventional DSA .Based on 3D‐DSA examination results including the location of the aneurysm ,the aneurysm neck size and tumor relations with the aneurysm ,40 patients underwent surgical or interven‐tional treatment ,20 patients were subjected to aneurysm surgery ,13 patients to embolization ,and 7 patients to emboliza‐tion treatment with stent .Conclusion In comparison to conventional DSA examination ,3D‐DSA examination can signifi‐cantly increase the detection rate of intracranial aneurysms tiny rate .Due to the advantages in demonstrating the size of the aneurysm neck ,the aneurysm and tumor structure ,3D‐DSA examination is beneficial to guide the treatment of intracranial aneurysms .