Ohtaki M, Tanabe S, Uede T, Hashi K
Department of Neurosurgery, Sapporo Medical University School of Medicine.
No Shinkei Geka. 1996 Nov;24(11):995-1002.
The accuracy of three-dimensional CT angiography (3D-CTA) for delineating atherosclerotic carotid stenosis was examined in comparison with digital subtraction angiography (DSA) in symptomatic patients. In cases undergoing carotid endarterectomy (CEA), the clinical usefulness of 3D-CTA for surgical planning was also evaluated in the light of intraoperative findings. From July 1992 to June 1995, 52 patients suffering from internal carotid ischemia and/or presenting carotid bruit were evaluated to detect carotid bifurcation stenosis by 3D-CTA. Shaded surface reconstruction (SSR) for three-dimensional display and maximum intensity projection (MIP) were employed in multiple projection to evaluate sites of stenosis. DSA was performed in 18 out of 31 patients having atherosclerotic carotid stenosis shown by 3D-CTA. MIP reconstructions accurately delineated sites of stenosis close to DSA and allowed precise depiction of ulcerated plaque and intramural calcification. The percentage of carotid stenosis was determined by comparing the narrowest point to the internal carotid artery (ICA) beyond the bulb on both 3D-CTA and DSA. Assessment of carotid stenosis was highly correlated between 3D-CTA and DSA (r = 0.987, p < 0.0001). In this series, 9 carotid arteries in 8 patients underwent CEA for severe stenosis. 3 patients with ICA occlusion and 1 patient with elongated severe stenosis underwent STA-MCA anastomosis. Using MIP reconstructions and two-dimensional original images it was found that ICA occlusion was apparently distinguished from high grade ICA stenosis. SSR provided valuable informations during CEA for atherosclerotic plaque regarding anatomical relationship with the internal jugular vein and bony structures. This advanced means of 3D-CTA can be adequate as a screening method to detect carotid stenosis in symptomatic patients and useful for surgical planning of CEA and post-operative follow-up examination.
在有症状的患者中，将三维CT血管造影（3D-CTA）与数字减影血管造影（DSA）相比较，以检查其描绘动脉粥样硬化性颈动脉狭窄的准确性。在接受颈动脉内膜切除术（CEA）的病例中，还根据术中发现评估了3D-CTA在手术规划中的临床实用性。从1992年7月至1995年6月，对52例患有颈内动脉缺血和/或出现颈动脉杂音的患者进行了评估，以通过3D-CTA检测颈动脉分叉狭窄。采用多平面的阴影表面重建（SSR）进行三维显示和最大密度投影（MIP）来评估狭窄部位。在31例经3D-CTA显示有动脉粥样硬化性颈动脉狭窄的患者中，18例进行了DSA检查。MIP重建能够准确描绘出与DSA相近的狭窄部位，并能精确显示溃疡斑块和壁内钙化。通过比较3D-CTA和DSA上颈内动脉（ICA）球部远端最窄点来确定颈动脉狭窄的百分比。3D-CTA和DSA对颈动脉狭窄的评估高度相关（r = 0.987，p < 0.0001）。在本系列中，8例患者的9条颈动脉因严重狭窄接受了CEA。3例ICA闭塞患者和1例长段严重狭窄患者接受了STA-MCA吻合术。通过MIP重建和二维原始图像发现，ICA闭塞明显有别于高度ICA狭窄。SSR在CEA期间为动脉粥样硬化斑块提供了有关其与颈内静脉和骨性结构解剖关系的有价值信息。这种先进的3D-CTA方法可作为一种筛查方法，用于检测有症状患者的颈动脉狭窄，并且对CEA的手术规划和术后随访检查有用。
