腦部電腦斷層血管造影術在神經外科之應用價值

目的：腦部電腦斷層血管造影術利用靜脈注射對比劑，以螺旋式電腦斷層切片取得原始影像，再重組成三度立體空間之血管影像。對神經外科之腦血管急症患者提供極具價值之診斷。病人及方法：自1998年1月至 9月，共有43位患者接受腦部電腦斷層血管造影檢查，其中男性27位，女性16位，年齡自20歲至80歲不等，平均年齡為54歲。其中腦動脈瘤占10例，動靜脈畸形6例，海綿竇血管瘤1例，高血壓性腦內出血19例，頭部外傷懷疑合併有腦血管病變有2例，腦梗塞有1例，腦膜炎1例，腦下垂體瘤1例，及壓力性頭痛疑似蜘蛛網膜下腔出血1例。以高速電腦斷層掃瞄，配合著視窗工作站電腦系統來完成。病人以每秒三毫升的速度注射非離子性對比劑後，約經18秒之停滯，再以每張1毫米(mm)之厚度行掃瞄檢查，約須30秒掃瞄時間即完成腦血管造影檢查。於電腦上可行表面拋光顯示(shaded surface display)、最大亮點投影(maximum intensity projection)及多層面重組(multiplanner reformation)方式等立體空間之影像重組。結果：在所有10例腦動脈瘤患者當中，3例為急性患者，直接在腦部電腦斷層造影檢查後即行手術，而未再行傳之腦血管造影，19例高血壓腦出血中有4例發現正出血之徵像。在5例腦動靜脈異常之患者中，3例是行術前血管叢(nidus)描繪，用來做腦立體定位放射手術(sterotactic radiosurgery)治療。結論：相較於傳統之腦血管造影及磁振血管造影，吾人發現腦部電腦斷層血管造影，有以下之優點：一、掃瞄時間短、非侵犯性，可用在病情嚴重患者。二、在急性自發性腦內出血之患者，用以釐清是否有不正常之血管病灶，可使神經外科醫師，篤定地行進一步手術治療。三、腦部電腦斷層血管造影之原始切片，及其立體空間之合成影像，可提供病變及其周圍之相關組織結構。對於神經外科之外科手術過程，可提供完整之資訊。

關鍵字

電腦斷層血管造影；電腦斷層；數位減贅性血管造影；動脈瘤

並列摘要

Objective: Helical computed tomography(CT) with rapid injection of contrast medium and angiographic reconstruction provides a non-invasive alternative to study cerebral vascular lesions. Patients and methods: From January 1998 to September 1998, CT angiography (CTA) was performed in 43 patients (27 men and 16 women; age range 20 to 80 years). Diagnoses of these patients included: aneurysm 10, AVM 6, hypertiensive cerebral hemorrhage 18, head injury 3, cerebral infarction 1, meningitis 1, pituitary tumor 1, cavernous angioma 1, and tension headache 1. CTA was performed using a General Electric High Speed Advantage Scanner coupled to an Advantage Windows Workstation. A total of 80 mg/L non-ionic contrast medium was administered at 3 mL/s with an 18-s scan delay. The slice thickness equaled 1 mm, and scanning time was about 30 s. A three-dimensional (3D) reconstruction can be obtained. Results: Of 10 aneurysm cases, 3 patients were operated on under visualization of cerebral aneurysm in CTA without the study of cerebral angiography. In 18 patients with hypertensive cerebral hemorrhage, 5 patients showed on-going bleeding signs. Of 5 cases of AVM, 3 are patients on which CTA images were used to perform stereotactic radiosurgery. One case of AVM showed on-going bleeding. Conclusions: CTA has the following advantages: (1) It can be used in critically ill, or ventilated patients because of short scan time (1-2 min) and non-invasiveness. (2) It can be used as a simple method to rule out unexpected vascular lesions in hypertensive intracerebral hemorrhage. (3) Source data sets and 3D reconstruction can provide microsurgical anatomy including both surrounding parenchyma and skull bone image, which are important for neurosurgeons to make decisions of surgical approach.

並列關鍵字

computed tomographic angiography ； computed tomography ； digital subtraction angiography ； aneurysm

國際替代計量

腦部電腦斷層血管造影術在神經外科之應用價值

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