Hsiang J N, Liang E Y, Lam J M, Zhu X L, Poon W S
Department of Surgery, Chinese University of Hong Kong, Shatin.
Neurosurgery. 1996 Mar;38(3):481-7 discussion 487. doi: 10.1097/00006123-199603000-00011.
Conventional cerebral angiography has always been regarded as the gold standard for intracranial aneurysm detection. However, conventional angiography has the disadvantages of being invasive and time consuming. We present here 30 patients who underwent computed tomographic angiography (CTA) with three-dimensional reconstruction for the detection of intracranial aneurysms. All of these patients had subarachnoid hemorrhage or suspected intracranial aneurysms. CTA was performed in all patients with the use of a General Electric Hispeed Advantage helical scanner. Iohexol, 135 ml, was used as the contrast agent. Twenty-five patients also underwent conventional angiography for comparison. The five patients who underwent CTA only did not have conventional angiography because of poor clinical condition, and four of them subsequently died. Five patients had subarachnoid hemorrhage, but the results of both CTA and conventional angiography were negative for aneurysms. One patient had an incidental finding of a 3-mm left posterior communicating artery aneurysm on CTA, which was confirmed by conventional angiography. In the remaining 19 patients, 19 saccular aneurysms and 1 fusiform aneurysm were detected by CTA. Locations and sizes were confirmed by conventional angiography in all except two. The first exception was a patient who had a 2.5-mm anterior communicating artery aneurysm detected by CTA but not by conventional angiography. Surgical exploration confirmed the CTA diagnosis. The other exception was a patient in whom a 2-mm right posterior communicating artery aneurysm was detected by CTA but in whom conventional angiography showed a 2-mm left posterior communicating artery aneurysm. Unfortunately, there was no surgical confirmation in this case because the family of the patient refused surgery. Our results have demonstrated that CTA is a quick, reliable, and relatively simple diagnostic tool for intracranial aneurysms. In an emergent situation, such as a deteriorating patient with a hematoma, it is superior to either empiric exploration or infusion computed tomographic scans because it delineates the orientation and configuration of the aneurysm and its associated vascular anatomy.
传统的脑血管造影一直被视为颅内动脉瘤检测的金标准。然而，传统血管造影具有侵入性和耗时的缺点。我们在此介绍30例接受计算机断层血管造影（CTA）三维重建以检测颅内动脉瘤的患者。所有这些患者均有蛛网膜下腔出血或疑似颅内动脉瘤。所有患者均使用通用电气Hispeed Advantage螺旋扫描仪进行CTA检查。使用135毫升碘海醇作为造影剂。25例患者还接受了传统血管造影以作比较。仅接受CTA检查的5例患者因临床状况不佳未进行传统血管造影，其中4例随后死亡。5例患者有蛛网膜下腔出血，但CTA和传统血管造影的动脉瘤检查结果均为阴性。1例患者在CTA检查中偶然发现左后交通动脉有一个3毫米的动脉瘤，传统血管造影证实了这一发现。在其余19例患者中，CTA检测到19个囊状动脉瘤和1个梭形动脉瘤。除2例患者外，所有患者的动脉瘤位置和大小均经传统血管造影证实。第一例例外是一名患者，CTA检测到前交通动脉有一个2.5毫米的动脉瘤，而传统血管造影未检测到。手术探查证实了CTA的诊断。另一例例外是一名患者，CTA检测到右后交通动脉有一个2毫米的动脉瘤，而传统血管造影显示左后交通动脉有一个2毫米的动脉瘤。不幸的是，由于患者家属拒绝手术，此例未进行手术证实。我们的结果表明，CTA是一种快速、可靠且相对简单的颅内动脉瘤诊断工具。在紧急情况下，如血肿患者病情恶化时，它优于经验性探查或灌注计算机断层扫描，因为它能描绘出动脉瘤的方向和形态及其相关的血管解剖结构。
