1.5T 3D-TOF-MRA与DSA诊断颅内动脉瘤的 研究价值对比

目的 探讨三维时间飞跃法磁共振血管成像（3D-TOF-MRA）与数字减影血管造影（DSA）诊断颅内动脉瘤的研究价值。方法 收集20例经DSA及手术确诊为颅内动脉瘤患者,术前均行MRA及DSA检查。MRA检查后经MRP、MIP及VR法重建并与DSA结果进行对比。结果 20例患者DSA检查出23个动脉瘤,MRA VR重建检查出21个动脉瘤,检出率为91.30%,MPR及MIP检查出20个,检出率为87.00%。结论 1.5T 3D-TOF-MRA对颅内动脉瘤有较高的敏感性和准确性,为临床诊断及治疗提供了详细的参考价值,但对于微小动脉瘤存在一定的漏诊现象,应选择DSA进行进一步检查。     

CTA检查对脑动脉瘤的诊断价值

目的探讨16层螺旋CT血管造影对引起蛛网膜下腔出血的脑动脉瘤的诊断价值及其对临床治疗的指导意义。方法对临床因蛛网膜下腔出血的患者进行CT血管造影检查,发现颅内动脉瘤并经介入或手术治疗的患者82例（介入治疗5例,手术治疗77例）。CT血管造影采用最大密度投影及容积重建法进行图像后处理,与DSA及手术结果对比。结果82例脑动脉瘤患者中,CT血管造影检查发现动脉瘤88个（6例均为2个动脉瘤）,手术证实82个（77例）,DSA证实6个（5例）。载瘤动脉分别为后交通动脉（38个）,前交通动脉（35个）,大脑中动脉（8个）,颈内动脉（5个）,基底动脉（1个）胼周动脉（1个）。CT血管造影显示动脉瘤的部位、大小、瘤颈结构及其与周围血管的关系等与手术结果基本一致。结论16层螺旋CT血管造影对脑动脉瘤的诊断准确率高,对脑动脉瘤与周围结构的关系显示良好,对临床治疗具有可靠的指导价值。     

双源CT血管成像在Willis环区动脉瘤诊断及治疗中的应用

目的:探讨双源CT血管成像(DSCTA)在Willis环区动脉瘤的诊断、分型及介入栓塞治疗中的临床应用价值.方法:术前采用DSCTA检查筛选颅内动脉瘤患者26例(33个).采用Seldinger技术,在DSA引导下行全脑血管造影,了解动脉瘤位置、形态、大小,测量瘤颈及瘤体直径;再根据不同的解剖学形态选用不同的介入栓塞方法治疗.结果:术前DSCAT和DSA检查对颅内动脉瘤的大小、位置、形状显示一致.26例患者共33个动脉瘤均成功栓塞,完全栓塞18个,占54.54%;栓塞程度在95%以上12个,占36.36%;不完全栓塞3个,占9.09%.结论:DSCTA检查和DSA全脑血管检查可提供颅内动脉瘤的位置、形态、大小等影像解剖学资料,为动脉瘤的临床分类和治疗方法的选择提供依据.     

颅内宽颈动脉瘤合并载瘤血管重度狭窄的血管内治疗

目的 探讨颅内宽颈动脉瘤合并载瘤动脉重度狭窄血管内治疗的安全性及疗效。方法 回顾性研究。纳入郑州大学人民医院脑血管病科2017年1月—2019年12月采用血管内治疗颅内宽颈动脉瘤合并载瘤血管重度狭窄的患者14例,共14个动脉瘤。14例中,男5例、女9例,年龄45~76(61.07±10.43)岁;8例为破裂动脉瘤,6例为未破裂动脉瘤。术前载瘤段血管狭窄率为70%~90%,中位数为70%。根据载瘤段血管狭窄与动脉瘤的解剖位置关系分型为Ⅰ型9例、Ⅱ型4例、Ⅲ型1例。分析患者临床及影像学资料,采用改良Rankin量表(mRS)评分评价患者临床预后,采用Raymond分级标准评估动脉瘤闭塞情况。结果 14例患者均采用先处理载瘤段血管狭窄再进行支架辅助弹簧圈栓塞动脉瘤的治疗方法,手术均成功。术后即刻造影示动脉瘤栓塞程度RaymondⅠ级12个、Ⅱ级2个,术后载瘤血管残余狭窄率20%~30%,中位数为25%。术后3个月14例患者mRS评分0分12例、2分1例、3分1例。11例患者获数字减影血管造影(DSA)随访,中位随访时间6.45(6~10)个月,DSA示Raymond Ⅰ级10例、RaymondⅡ级1例,11例患者均未出现支架内再狭窄或闭塞情况。结论 颅内宽颈动脉瘤合并载瘤血管重度狭窄病变复杂,采用先处理载瘤段血管狭窄再进行动脉瘤栓塞的治疗方法可能是安全、有效的,还需大样本病例的长期随访研究。     

GE Revolution CT在颅内动脉瘤诊疗中的应用

目的 探讨GE Revolution CT在颅内动脉瘤中的诊断价值。方法 选取我院收治的高度疑为颅内动脉瘤的95例患者,均行GE Revolution CT与数字减影血管造影术(DSA)检查。以外科手术结果为“金标准”,评价GE Revolution CT检查与DSA检查对颅内动脉瘤的诊断价值。患者术后随访9～12个月,采用GE Revolution CT与DSA进行复查,评价颅内动脉瘤残留情况。结果 GE Revolution CT检出阳性患者75例,颅内动脉瘤98个;DSA检出阳性患者77例,颅内动脉瘤100个;手术确诊阳性患者78例,颅内动脉瘤101个。GE Revolution CT与DSA检查颅内动脉瘤部位的符合率(97.03%vs.99.01%)比较,差异无统计学意义(P>0.05)。GE Revolution CT检出颅内动脉瘤的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为96.15%、100%、96.25%、100%和40.00%,与DSA的诊断结果比较差异无统计学意义(P>0.05)。GE Revolution CT检出术后颅内动脉瘤残留5个,DS...     

3D-MRA与DSA技术在脑血管病变诊断中的对比研究

目的探讨三维磁共振血管造影(3D-MRA)分段采集技术与数字减影血管造影(DSA)技术在脑血管病变诊断中的特点。方法选择50例脑血管疾病患者,其中男性29例,女性21例;年龄12~79岁,平均年龄56.2岁。分别行3D-MRA分段采集技术与DSA技术,并比较两种方法对脑血管病变诊断的准确性及特点。比较两种检查方法发现颅内病变的差异;将动脉瘤按直径大小分为2组,即≥3.0mm组和3.0mm组,比较两种检查方法发现颅内动脉瘤的差异。结果 50例患者中,3D-MRA发现颅内动脉瘤25例,DSA发现颅内动脉瘤26例;脑动静脉畸形、动脉瘤术后复查、烟雾病各5例,脑血管狭窄9例。其中,DSA诊断率为100%(50/50),3D-MRA诊断率为98%(49/50)。3D-MRA与DSA均可以立体、直观地显示脑血管的空间解剖细节,可充分观察到脑动脉瘤的准确起源、瘤体大小、颈部宽窄及血管走向等情况,病例中所显示的最小动脉瘤直径3D-MRA约2.6 mm,DSA约2.0 mm,3D-MRA漏诊1例直径约2.0 mm小动脉瘤。3D-MRA与DSA两种检查方法发现颅内病变差异无统计学意义(P0.05);动脉瘤直径3.0mm,差异有统计学意义(P0.05)。结论 3DMRA与DSA血管造影技术相比,3D-MRA与DSA均能较好地显示颅内血管病变,但是3D-MRA对小于2.0 mm的小动脉瘤易漏诊。     

大脑浅表吻合静脉 64层CT血管成像研究及其意义

目的    探讨正常人大脑外侧面浅表吻合静脉的CT血管成像表现。 方法    采用64层螺旋　CT对90例受检者行头部CTV检查，应用CT三维重建技术重建大脑浅表吻合静脉的三维血管影像。  结果    ①CTV图像中大脑浅表静脉吻合分为6型，Ⅰ～Ⅵ型分别占：34%（31例）、43%（39例）、9%（8例）、49%（44例）、33%（30例）及3%（3例）；浅表静脉间的吻合个体差异较大，单侧大脑半球浅表静脉吻合显示类型以1～3种居多，3种以上较少见，8%（7例）双侧大脑半球未发现任何类型的浅表静脉吻合；②参与构成静脉吻合的浅静脉共349支，左侧182支，右侧167支，两侧比较差异无统计学意义（P＞0.05）；　Trolard静脉、Labbe静脉及参与构成静脉吻合的Sylvian静脉的数量分别为97支、112支、140支。  结论64层螺旋CT血管成像是一种简便、快速、无创性显示大脑浅表吻合静脉的检查手段，可为临床相关手术入路的选择和脑血管疾病的诊断提供依据。     

旋转DSA诊断颅内动脉瘤更具优势——旋转DSA与MRA的对比研究

目的比较旋转数字减影血管造影（digitalsubtraction angiography，DSA）与磁共振血管成像（magnetic resonance angiography，MRA）在颅内动脉瘤诊断中的价值。方法40例疑为颅内动脉瘤的患者同时行旋转DSA和MRA检查。评估旋转DSA显示动脉瘤的个数、部位、大小、形态、动脉瘤颈及与载瘤动脉的关系，并与MRA进行比较分析。结果40例患者共40个动脉瘤，旋转DSA检查发现39个，敏感性为97．5％，直径大小为2～30mm。MRA检查发现36个，敏感性为90％，直径大小为4-30mm。旋转DSA检查对动脉瘤的全貌、瘤颈的位置和结构及与周围血管分支的解剖关系均能清晰显示。旋转DSA显示动脉瘤的部位、大小和形态同MRA基本一致。结论旋转DSA技术在颅内动脉瘤诊断和治疗中具有极其重要的作用，在敏感性和特异性方面优于MRA，不但可明确诊断，而且还有利于临床治疗方式的选择。     

320排容积CTA对颅内动脉瘤的诊断价值

目的探讨320排容积cT血管成像（CTA）对颅内动脉瘤诊断价值。方法选取医院2010年2月-2013年12月间具有完整颅脑数字减影血管造影（DSA）资料的63例颅内动脉瘤患者,所有患者均于起病3d内完成320排容积CTA检查。以DSA检查结果作为诊断金标准,分析病变的影像学特点,并评价320排容积CTA对颅内动脉瘤诊断的准确性。结果颅脑动脉瘤阳性63例,CTA漏诊1例,病灶位于大脑后交通动脉。320排容积CTA对颅内动脉瘤的诊断敏感度及阳性预测值分别为98．41％、100％。按部位统计动脉瘤数量结果如下：颈内动脉海绵窦段4例,大脑前动脉26例,大脑中动脉4例,大脑后动脉8例,大脑前交通动脉10例,大脑后交通动脉5例,基底动脉6例。动脉瘤瘤径为2～22mm。在CTA上,动脉瘤的瘤体位置、大小、瘤颈、瘤顶指向、载瘤动脉及动脉瘤与邻近血管分支和骨性结构的空间关系均能较满意的显示,均与DSA结果相符。结论320排容积CTA诊断颅脑动脉瘤具有较高敏感性,能准确检出颅内的微小动脉瘤,对动脉瘤的空间解剖关系显示更具优势。因此,在临床工作中,320排容积CTA可以成为颅脑动脉瘤的首选影像学检查方法。     

3.0T 3D-TOF MRA对颅内动脉瘤检出率的临床应用研究

目的评价3.0 T时间飞跃法磁共振血管成像(3.0 T 3D-TOF MRA)对颅内动脉瘤的诊断价值。方法选择25例有颅内动脉瘤相关症状患者,其中男性14例,女性11例;年龄25～74岁,平均年龄57岁。对其3.0 T 3D-TOF MRA诊断为颅内动脉瘤患者的磁共振资料进行回顾性分析,并与数字减影血管造影(DSA)对照。结果3.0 T 3D-TOF MRA共显示28个动脉瘤,其中单发22例,3例为多发动脉瘤,起自颈内动脉系统25个;起自基底动脉系统3个;DSA检查共显示27个动脉瘤。结论3.0 T 3D-TOF MRA虽然对于直径≤3 mm的微小动脉瘤的诊断存在一定的误诊及漏诊率,但其诊断颅内动脉瘤时能比较全面地显示动脉瘤,三维信息对临床确立治疗方案有很大帮助。3.0 T 3D-TOF MRA不失为高危人群或临床怀疑颅内动脉瘤患者筛查及随诊观察的有效手段。     

人工智能辅助分析CTA影像诊断颅内动脉瘤的临床研究

目的探讨在CT血管造影(CTA)中采用传统人工、人工智能(AI)及两者联合对颅内动脉瘤的检出效能。方法纳入我院疑似颅内动脉瘤并行CTA及数字减影血管造影术(DSA)检查的患者359例,以DSA检查为金标准,分别采用传统人工、AI及两者联合分析CTA图像,计算3种方法对颅内动脉瘤诊断的灵敏度、特异度、假阳性率、假阴性率及准确度,并对传统人工、AI动脉瘤漏诊及误诊的原因进行分析。结果传统人工组、AI组、人工联合AI组对颅内动脉瘤的检出率分别为92.12%、92.12%、95.92%,组间比较差异无统计学意义(P>0.05)。人工联合AI诊断颅内动脉瘤的灵敏度、特异度及准确度分别为95.92%、92.42%及95.39%,高于单一诊断;假阳性率(7.58%)、假阴性率(4.08%)均低于单一诊断。传统人工及AI在毗邻骨质、合并动静脉畸形/烟雾病/夹闭术后复发、非责任动脉瘤方面比较差异有统计学意义(P<0.05)。结论传统人工联合AI对颅内动脉瘤诊断的灵敏度、特异度及准确度较单一方法高,其可降低颅内动脉瘤的漏诊率及误诊率。     

Computer-Aided Detection of Intracranial Aneurysms in MR Angiography

Intracranial aneurysms represent a significant cause of morbidity and mortality. While the risk factors for aneurysm formation are known, the detection of aneurysms remains challenging. Magnetic resonance angiography (MRA) has recently emerged as a useful non-invasive method for aneurysm detection. However, even for experienced neuroradiologists, the sensitivity to small (<5 mm) aneurysms in MRA images is poor, on the order of 30~60% in recent, large series. We describe a fully automated computer-aided detection (CAD) scheme for detecting aneurysms on 3D time-of-flight (TOF) MRA images. The scheme locates points of interest (POIs) on individual MRA datasets by combining two complementary techniques. The first technique segments the intracranial arteries automatically and finds POIs from the segmented vessels. The second technique identifies POIs directly from the raw, unsegmented image dataset. This latter technique is useful in cases of incomplete segmentation. Following a series of feature calculations, a small fraction of POIs are retained as candidate aneurysms from the collected POIs according to predetermined rules. The CAD scheme was evaluated on 287 datasets containing 147 aneurysms that were verified with digital subtraction angiography, the accepted standard of reference for aneurysm detection. For two different operating points, the CAD scheme achieved a sensitivity of 80% (71% for aneurysms less than 5 mm) with three mean false positives per case, and 95% (91% for aneurysms less than 5 mm) with nine mean false positives per case. In conclusion, the CAD scheme showed good accuracy and may have application in improving the sensitivity of aneurysm detection on MR images.     

Points to consider when evaluating three-dimensional digital subtraction angiography of intracranial aneurysms and their effects on treatment

Background/aimIn this study, we aimed to investigate what should be regarded as potential determinants of treatment strategies when evaluating 3D digital subtraction angiography (DSA) images.Material and methodsOur inclusion criteria were as follows: (1) presence of at least one intracranial aneurysm demonstrated by conventional angiography, (2) having both 2D and 3D images, and (3) being over 18 years old. First, two-dimensional (2D) and then 3D angiography images of 226 aneurysms of 150 patients were scanned. Morphological characteristics such as size, configurations, relationship with parent artery, baby counts, and other incidental findings were determined.ResultsOf the 226 aneurysms, 11 (4.9%) were only detected on 3D images. Four of these 11 additional aneurysms were believed to be babies of other aneurysms seen in 2D images. Middle cerebral artery (MCA) M1 segment was the most common localization in terms of missed aneurysms. Of the 28 aneurysms located in the communicating segment of the internal carotid artery, the absolute locations of 7 (25%) could not be detected in 2D images or detected in the wrong location. Of the 24 aneurysms located in the ophthalmic segment, the origin of 8 (33%) could not be clearly identified in 2D images. Truncus relationships of MCAs bifurcation/trifurcation aneurysms were seen in 41 of 63 aneurysms (65%) on 2D images, whereas all were confirmed on 3D images. Fenestrations not seen in 2D images were identified in 3D images of 4 patients (3%).ConclusionThe superiority of 3D images compared to 2D images in determining the morphologic characteristics of intracranial aneurysms has been known for a long time. The contribution of 3D images to the treatment can be summarized as evaluating the parent artery relationship, revealing the number and shapes of aneurysm babies more clearly, detecting fenestrations, and shortening procedure time by finding the correct working angle.     

MSCT图像后处理在显示翼腭窝结构中的价值

目的　探讨多层螺旋CT的各向同性扫描对于翼腭窝结构及其相关通道的完整显示,多平面重组(MPR)步骤,及其临床应用价值。 方法　运用Siemens 16 CT扫描仪行鼻窦螺旋CT检查,选取　100名无翼腭窝及其通道病变的成人,由工作站进行容积显示(VR)、最大密度投影(MIP)及多平面重组　(MPR),观察翼腭窝结构及其通道的形态、走行。 结果　圆孔、翼管、蝶腭孔、翼腭管、腭鞘管、犁鞘管在其最佳辨认方位上显示率分别为99%、98%、99%、96%、96%、85%。　结论　多层螺旋CT能多方位而且直观地显示翼腭窝骨性结构及其通道,能为早期发现相关病变及为制订临床治疗方案提供影像学依据。     

肩袖损伤诊断与治疗方法的选择

目的 探讨肩袖损伤的临床诊断及治疗方法,并评价治疗效果。 方法 选择我院2004年7月~2008年7月收治的48例肩袖损伤患者,依患者分类采用非手术综合治疗及手术治疗。非手术综合治疗组17例,采取休息制动、中药或非甾体抗炎药口服、外用药物、封闭、牵引等方法。手术组31例采用肩关节外侧切口,切除喙肩韧带,肩峰成形,探查修整肩袖,褥式缝合冈上肌腱、冈下肌腱及肩胛下肌腱,术后肩关节外展位石膏固定。 结果 48例均得到半年以上随访,平均随访13个月,采用UCLA评分系统评价,其中手术治疗组中优20例,良10例,差1例,术后优良率96.8％,非手术综合治疗组优8例,良6例,差3例,优良率82.4%。 结论 对于NeerⅡ、Ⅲ期应积极采用手术治疗,是提高效果的关键。     

64层螺旋CT脑动脉瘤血管成像的应用研究

目的：评价64层螺旋CT脑动脉成像在脑动脉瘤诊断中的临床应用价值。方法：57例患者全部进行了脑动脉CTA和DSA检查,将DSA检查结果作为参考标准,评估CTA诊断脑动脉瘤的敏感性、特异性、准确性以及阴性预测值。结果：脑动脉CTA49例共有50个动脉瘤,而DSA检查51例发现52个动脉瘤。CTA诊断动脉瘤的特异性为100％,敏感性96．08％,准确性96．5％,阴性预测值75％。结论：64层螺旋CT脑动脉成像诊断动脉瘤特异性、敏感性和准确性高,可以作为脑动脉瘤筛查和术前评估的首选方法,但仍有假阴性,不能完全取代DSA。     

Computerized detection of intracranial aneurysms for three-dimensional MR angiography: feature extraction of small protrusions based on a shape-based difference image technique

We have improved a computerized scheme for the detection of intracranial aneurysms for three-dimensional (3-D) magnetic resonance angiography (MRA) by the use of image features of small protrusions extracted based on a shape-based difference image (SBDI) technique. Initial candidates were identified by use of a multiple gray-level thresholding technique in dot enhanced images, and by finding short branches in skeleton images. Image features related to aneurysms were determined based on candidate regions segmented by use of a region growing technique. For extracting additional features on small protrusions or small aneurysms, we have developed an SBDI technique, which was based on the shape-based difference between an original segmented vessel and a vessel with suppressed local change in thickness. The SBDI technique was useful for obtaining local changes in vessel thickness, i.e., SBD regions, which could be small aneurysms in the case of true positives, but thin or very small regions in the case of false positives. Many false positives were removed by means of rule-based schemes and linear discriminant analysis on various 3-D localized image features, including SBDI features. We tested the computerized scheme on 53 cases with 61 aneurysms and 62 nonaneurysm cases based on a leave-one-out-by-patient test method. As a result, false positives per patient decreased from 5.8 to 3.8, while a high sensitivity of 97% was maintained by use of the SBDI technique, in which SBDI features were effective for removing some false positives. The computer-aided diagnostic (CAD) scheme may be robust and useful in assisting radiologists in the detection of intracranial aneurysms for MRA.     

3D -DSA 与 3D -256 层 螺旋 CTA 在 颅内动脉瘤检查中对比研究简

目的利用数字减影血管造影（DSA）旋转三维成像（3D-DSA）与三维256层螺旋CT血管造影对比（3D-CTA）.探索其对颅内动脉瘤（AN）（尤其是直径〈3mm的微小AN）的探测能力有无进一步的提高.以及3D-CTA与3D-DSA不同技术之间的对颅内AN检出率的一致性分析。方法临床表现高度怀疑为AN或磁共振血管造影（MRA）怀疑为AN56例患者.其中男性31例,女性25例;年龄38～78岁,平均年龄49岁。全部行头颈联合3D-CTA及3D-DSA检查：由2名影像医师盲法独立判读CTA图像,由1名神经介入医师和1名介入影像医师共同判读3D-DSA图像。以3D-DSA为“金标准”,评估3D-CTA的灵敏度、特异度及不同技术之间的一致性。结果3D-DSA在56例患者中的47例共检出59个AN病灶.其余9例未发现AN。3D-CTA检出AN54个,灵敏度为93-20％～94.90％（均值94.05％）,特异度为81.8％。100.0％（均值90.9％）：对于AN病灶直径〈3mm,3D-CTA的灵敏度和特异度均值分别为86_4％和95.0％。对AN的检出.3D-CTA判读者之间及3D-CTA与3D-DSA不同技术之间一致性均为优（分别为K=0.847,均值K=0.802）：对于AN瘤体最大径的测量。3D-CTA判读者之间及3D-CTA与3D-DSA间差异均无统计学意义（P〉0.05）。结论3D-256层螺旋CTA对直径〈3mm的微小AN灵敏度和特异度均有所提高,判读者之间及与3D-DSA之间的一致性较高,可以作为疑似AN患者的首选筛查方法。两者联合可提高AN的检出率.为介入治疗AN提供可靠的影像学依据。