Diagnosis and Technical Consideration of CT Angiography for Intracranial Aneurysm

電腦斷層血管攝影(CTA)用於自發性蛛網膜下腔出血的病人，以診斷其血管瘤之存在與否，已有不少國內外學者肯定。本文的目的，乃是回溯性統計本院之較大規模使用CTA檢查，診斷出顱內血管瘤的發生位置，與手術結果比較，並加強於立體影像後處理及診斷方式上的探討。在三年的期間內，我們為臨床上診斷或電腦斷層確定之自發性蛛網膜下腔出血的病人，從事CTA之檢查。在所有受檢的92例病患之中，有43人發現了血管瘤（佔47.3%），並有46個血管瘤被發現，其中3人分別有兩個血管瘤，大小介於1.6到17.3 mm；另有6例患者為動靜脈畸形（AVM, 佔6.6%）；其餘42例並未發現血管異常（佔46.1%）。我們的電腦斷層掃描儀是探用奇異(GE)公司的Hi-Speed Advantage Spiral CT scanner，配合工作站SUN Sparc 20，執行影像後處理軟體GE Advantage Window, version 1.2。整個CTA的影像後處理及診斷，完全是由放射診斷科醫師親自操作。我們嘗試定出五個常規的投射角度，稍作旋轉，輔以原始影像，當場在工作站上診斷血管病變。在43例被診斷有血管瘤的病患中，有30位患者接受手術，結果在其中的29位病人找到了30個血管瘤，在1例病人找不到任何血管瘤，以接受手術的病人統計，CTA陽性之正確率為96.8%。根據我們的結果，認為經由影像後處理及診斷方式的改進，使得CTA診斷顱內小血管瘤（介於2-5mm）成為可能，並能確切呈現出大多數血管瘤的頸部(neck)及底部(dome)的方向，提供了足夠的資訊，使得不經傳統的血管攝影而直接進行手術成為可能。

關鍵字

電腦斷層血管攝影；立體影像重組；顱內血管瘤；蛛網膜下腔出血

並列摘要

Computed tomographic angiography (CTA) for diagnosing intracranial aneurysms in patients with spontaneous subarachnoid hemorrhages (SAH) has been well documented and widely accepted. In this study, we retrospectively documented a large series of 92 patients with spontaneous SAH in our hospital on whom CTA was performed for the diagnosis of intracranial vascular lesion. We correlated the CTA results with operative findings, and furthermore, focused on discussion of three-dimensional (3D) image post-processing and diagnostic methods. During a 3-year period from July 1995 through January 1999, we performed CTA for 92 patients diagnosed as spontaneous SAH. Forty-six aneurysms were disclosed in 43 patients (47.3%), three of the patients had two aneurysms each. The aneurysms ranged in size from 1.6 to 17.3 mm. Six other patients were noted with arteriovenous malformation (AVM, 6.6%), and the remaining 42 patients had negative results for CTA survey (46.1%). The CT equipment used was a Hi-Speed Advantage Spiral CT scanner (GE Medical Systems, U.S.A.), along with post-processing software (Advantage Window version 1.2, GE Medial Systems, U.S.A.) running on a Sparc 20 workstation (Sun Microsystems, Inc. U.S.A.). All the procedures of post-processing and diagnosis were performed by a radiologist. We tried to set up five routine projections, apply free rotation, correlate with the original axial images, and make diagnoses of the vascular lesions on the workstation. Among the 43 patients diagnosed with intracranial aneurysms, 30 of them were operated on by neurosurgeons. Finally, 30 aneurysms were found in 29 patients, and no aneurysm could be found in one patient. Corresponding to the operative findings, the correct predictive rate of the CTA was 96.8%. According to our results, with some improvement of the image post-processing and the diagnostic method, we made the diagnoses of small intracranial aneurysms (2 to 5 mm) using CTA with more confidence. With CTA, we located the origins of the aneurysms as well as the direction of domes. Such improvements of CTA offers much information for neurosurgeons to proceed to operation without the need of conventional angiography.

並列關鍵字

CT angiography ； 3-D reconstruction ； Intracranial aneurysm ； Subarachnoid hemorrhage

國際替代計量

Diagnosis and Technical Consideration of CT Angiography for Intracranial Aneurysm

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