Dündar Tolga Turan, Aralaşmak Ayşe, Özdemir Hüseyin, Seyithanoğlu Mehmet Hakan, Uysal Ömer, Toprak Hüseyin, Kitiş Serkan, Özek Erdinç, Alkan Alpay
Bezmialem Vakif University, Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey.
Turk Neurosurg. 2017 Oct 18. doi: 10.5137/1019-5149.JTN.21113-17.2.
To compare effectiveness of contrast-enhanced MRA (CE-MRA), 3D-Time-of-flight MRA (3D-TOF-MRA) and subtracted CTA from CTP (sub-CTA) in residue evaluation of intracranial aneurysms treated either with coiling or clipping.
Sixteen treated aneurysms, which were evaluated with three methods within two weeks after the operation, were enrolled. The success of each imaging techniques in demonstration of residue aneurysm and nearby vessels was compared by Fisher's Exact Test. The differences among three was evaluated by Cochran's Q test (p ≤ 0.05).
Perfusion abnormality was noted in % 81 of clipped and none of coiled patients. Vessel visualization in the vicinity of aneurysm was better in sub-CTA, followed by CE-MRA. In clipped aneurysms, sub-CTA revealed residue aneurysms in % 16,7 of the patients while 3D-TOF-MRA and CE-MRA revealed none. In coiled aneurysms, CE-MRA revealed residue aneurysms in 100 %, and TOF-MRA in 33,3 % while sub-CTA revealed none. Although dramatic differences were noted in the evaluation of residue aneurysm as well as nearby vessel visualization, no statistical significance noted due to very few patients in subcategories Conclusion: This is first study comparing the effectiveness of CE-MRA, 3D-TOF MRA and sub-CTA in residue aneurysms evaluation. Vessel visualization in the vicinity of aneurysm was better in sub-CTA in all regardless of coiling or clipping. Residue aneurysms were more commonly revealed by CE-MRA in coiled patients and more commonly and better shown by sub-CTA in clipped patients in addition of showing perfusion abnormality that's is more common in clipped patients.
比较对比增强磁共振血管造影(CE-MRA)、三维时间飞跃磁共振血管造影(3D-TOF-MRA)以及CT灌注成像减影CT血管造影(sub-CTA)在评估颅内动脉瘤栓塞或夹闭术后瘤体残留情况中的有效性。
纳入16例接受治疗的动脉瘤患者,术后两周内采用三种方法对其进行评估。通过Fisher精确检验比较每种成像技术在显示残留动脉瘤及附近血管方面的成功率。采用Cochran Q检验评估三者之间的差异(p≤0.05)。
在接受夹闭术的患者中,81%出现灌注异常,而接受栓塞术的患者均未出现。sub-CTA对动脉瘤附近血管的显示效果最佳,其次是CE-MRA。在接受夹闭术的动脉瘤患者中,sub-CTA显示16.7%的患者存在残留动脉瘤,而3D-TOF-MRA和CE-MRA均未显示。在接受栓塞术的动脉瘤患者中,CE-MRA显示100%的患者存在残留动脉瘤,TOF-MRA显示33.3%的患者存在残留动脉瘤,而sub-CTA均未显示。尽管在评估残留动脉瘤及附近血管显示方面存在显著差异,但由于各亚组患者数量极少,未发现统计学意义。结论:这是第一项比较CE-MRA、3D-TOF MRA和sub-CTA在评估残留动脉瘤有效性的研究。无论动脉瘤是接受栓塞术还是夹闭术,sub-CTA对动脉瘤附近血管的显示效果均最佳。在接受栓塞术的患者中,CE-MRA更常显示残留动脉瘤;在接受夹闭术的患者中,sub-CTA更常且更好地显示残留动脉瘤,此外还能显示在接受夹闭术的患者中更常见的灌注异常。