摘要
脑动脉瘤引起蛛网膜下腔出血（ＳＡＨ）是一种严重疾病，约５０％以上病人死亡或严重致残，重视本病诊断及治疗具有重要临床意义。病理学： １ｃｍ以下囊状动脉瘤多见，８０％～９０％单发，９０％起自ＩＣＡ系统，病因为先天性、外伤性、肿瘤性、感染性、动脉硬化性等。影像学表现：平片价值有限；血管造影为诊断动脉瘤可靠的方法；增强ＣＴ可发现７５％≥３ｍｍ的动脉瘤；ＣＴＡ发现率（＞２ｍｍ）为７０％～９０％；当天ＣＴ可查出９５％ ＳＡＨ，依出血部位８０％可推测出血动脉瘤的位置；ＭＲＩ可显示动脉瘤及血栓表现，但对ＳＡＨ不如 ＣＴ敏感；３Ｄ ＴＯＦ、ＰＣ ＭＲＡ检出率达７５％，ＰＣ对＞１５ｍｍ动脉瘤敏感性、特异性高。介入放射学治疗：动脉瘤治疗包括：１．去结构方式，即闭塞动脉瘤起源处的载瘤动脉，多用球囊和微弹簧圈；２．重建方式，即选择性闭塞动脉瘤同时保持载瘤动脉血流通畅，多用ＧＤＣ。早期微球囊导管系统血管成形术治疗颅内血管痉挛效果良好。
Aneurysmal subarachnoid hemorrhage (SAH) is a serious disease with more than 50% combined morbidity and mortality. Diagnosis and treatment are of clinical significance. Pathology: the saccular aneurysms smaller than 1cm are common, 80%-90% are single, 90% arise from internal carotid arery system. The pathogenesis cause for aneurysm include congenital, neoplastic, traumatic, inflammatory and atherosclerosis. Imaging of aneurysm: contrast enhanced CT can demonstrate 75% of aneurysms larger than 3mm. CTA can demonstrate 70% -90% of aneurysms larger than 2mm. CT demonstrate 95% SAH within 24 hours after ictus. The location of SAH may define location of the aneurysm in 80% cases. MRI can demonstrate aneurysm and thrombus inside, but show lower sensitive to SAH than CT. 3D TOF, PC MRA can demonstrate 75% of aneurysms. PC MRA had high sensitivity and specficity to aneurysms larger than 15mm. Angiography is the gold standard for the diagnosis of aneurysm. Interventional treatment of aneurysm: There were two approach: 1 Deconstructive approach: occluded the parent vessel from which the aneurysm arises with balloons or coils; 2 .Reconstructive approach: selectively occluded the aneurysm with the parent vessel presentation. At present, GDC is used widely. The microballoon catheter angioplasty was proved to be effective to cerebral vasospasm.
出处
《中国医学计算机成像杂志》
CSCD
2000年第1期51-56,共6页
Chinese Computed Medical Imaging
