- 期刊
Supplementary Use of Computed Tomographic Angiography in Subarachnoid Hemorrhage with Negative Digital Subtraction Angiography: Report of a Case
以電腦斷層血管攝影輔助血管攝影陰性之腦內蜘蛛網膜下腔出血：病例報告
摘要
隨著電腦斷層解像技術及重組技術的進步，電腦斷層血管攝影(CTA)已被廣泛地應用於偵測腦內動脈瘤的發生。基於CTA所具有的多方面特點，例如：非侵入性、檢查所需時間短、以及所得到的影像為高解像度的立體影像，使得電腦斷層血管攝影成為篩檢腦內動脈瘤高危險群病患的首選。此篇文章，敘述一位五十七歲的自發性蜘蛛網膜下腔出血(SAH)患者，其最初的DSA血管攝影並未顯示有腦內動脈瘤存在。然而，經過四十八小時後的CTA檢查，發現一明顯的動脈瘤頸部位於腦內前交通動脈上。經由左側額部的開顱手術，此動脈瘤順利夾除，及時挽救此位病患的生命。此處所提出的案例明白地呈現遭DSA血管攝影所遺漏的動脈瘤被CTA捕獲成功，避免了一場悲劇的發生。吾等將藉由此不常見的影像呈現，提出解釋：部分栓塞性腦內動脈瘤破裂可能為導致正常DSA及不正常CTA顯像的腦內蜘蛛網膜下腔出血的原因。
關鍵字
無資料並列摘要
With advances of resolution and re-combination techniques in computed tomography (CT), CT angiography (CTA) has frequently been employed to detect intracranial aneurysms. Its advantages, such as being non-invasive and time efficient, as well as the high resolution and 3-dimensional images obtained, have made it the preferred choice for screening patients at high-risk for intracranial aneurysms. Here we report the case of a 57-year-old man whose initial digital subtraction angiography (DSA) was negative. However, a follow-up CTA revealed a neck of intracranial aneurysm on the anterior communicating artery 48 hours later. This aneurysm was clipped successfully through the left sub-frontal approach and the patient made a good recovery following the surgery. In this case, a DSA-missed aneurysm was picked up by CTA and a catastrophe was prevented. We have thus shown DSA-negative pictures in CTA-positive subarachnoid hemorrhage, and the reason for this unusual image presentation was probably intra-aneurysmal thrombosis, which was confirmed by surgery.
延伸閱讀
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