Department of Neuroradiology, Rouen University Hospital, 1 rue de Germont, Rouen-cedex, France.
Acta Neurochir (Wien). 2010 May;152(5):793-802. doi: 10.1007/s00701-009-0465-4. Epub 2009 Jul 29.
The aim of our study was to evaluate the diagnostic efficacy of multislice computed tomographic angiography (MSCTA) regarding exclusion quality after aneurysm clipping.
Sixty patients (74 aneurysms) underwent microsurgical exclusion using titanium clips. The presence of aneurysm remnants on MSCTA was compared by a neuroradiologist to 2D digital subtraction angiography (DSA), which was considered as a reference examination. The contribution of 3D DSA was assessed in a subpopulation of 29 patients (35 aneurysms).
With 2D DSA, six aneurysm remnants (8%) were diagnosed, and only five (7%) by MSCTA. The specificity and sensitivity were 98.5 and 83%, respectively. MSCTA failed to demonstrate one large remnant (>2 mm) because of clip artifacts (six clips). With 3D DSA six supplementary remnants were diagnosed. Two were large remnants blinded by vessel overlaps and clip artifacts. Four were small "dog-eared" remnants (< or =2 mm). No additional treatment was required for small remnants.
In the postoperative period, MSCTA was considered a useful tool to evaluate the large remnants as well as a non-invasive ulterior examination for suspected bifurcation. Nevertheless, 3D DSA is still required for an accurate evaluation of aneurysms treated by more than three clips.
本研究旨在评估多层螺旋 CT 血管造影（MSCTA）在夹闭动脉瘤后的排除质量方面的诊断效能。
60 例（74 个动脉瘤）患者接受了钛夹显微外科夹闭。由神经放射科医生将 MSCTA 上存在的动脉瘤残余与二维数字减影血管造影（2D DSA）进行比较，2D DSA 被认为是参考检查。在 29 例患者（35 个动脉瘤）的亚组中评估了 3D DSA 的作用。
2D DSA 诊断出 6 个动脉瘤残余（8%），而 MSCTA 仅诊断出 5 个（7%）。特异性和敏感性分别为 98.5%和 83%。由于夹闭伪影（6 个夹），MSCTA 未能显示一个大的残余物（>2mm）。3D DSA 诊断出 6 个补充的残余物。其中 2 个为大的残余物，由于血管重叠和夹闭伪影而被遮挡。4 个为小的“犬耳状”残余物（<=2mm）。小残余物无需额外治疗。
在术后期间，MSCTA 被认为是评估大残余物的有用工具，也是疑似分叉处的非侵入性后续检查。然而，对于用超过 3 个夹治疗的动脉瘤，仍然需要 3D DSA 进行准确评估。
