计算机断层扫描血管造影在中枢神经系统疾病中应用的研究进展

摘要/Abstract

摘要：

随着多层螺旋计算机断层扫描及重组技术的发展，由于计算机断层扫描血管造影（computed tomography angiography，CTA）具有操作简便、微创的特点，其在中枢神经系统的应用越来越广泛，它不仅可为急性脑血管病、动脉瘤、脑动静脉畸形、烟雾病、脑静脉血栓形成及脊髓血管病变的诊断提供依据，对预测脑出血后血肿的再扩大也有重要意义。本文将就CTA在这些疾病中的技术优势、技术特点以及临床研究热点做一综述。

文章导读： 【点睛】
本文就计算机断层扫描血管造影在急性脑血管病、动脉瘤、脑动静脉畸形、烟雾病、脑静脉血栓形成及脊髓血管病变等疾病研究中的优势、特点进行综述。

关键词: 血管造影; 计算机断层扫描; 中枢神经系统

Abstract:

With the development of multi-slice computer tomography scan and recombinant techniques, computed tomography angiography(CTA) is widely used in central nervous system due to its convenient operation and minimal invasion. It contributes to the diagnosis of acute cerebral vascular diseases, aneurysm, arteriovenous malformations, moyamoya disease, tumors and spinal vascular disease, and provides evidence to the growth of massive hematoma. This paper reviews the imaging advantage, imaging technology and clinical research focus of CTA in the diseases.

Key words: Angiography; Computed tomography; Central nervous system

周洋1，3，高培毅1，2，3，薛静1，2，3. 计算机断层扫描血管造影在中枢神经系统疾病中应用的研究进展[J]. 中国卒中杂志, 2013, 8(02): 133-137.

ZHOU Yang*, GAO Pei-Yi, XUE Jing.. Research Advance on Computed Tomography Angiography in Central Nervous System Diseases[J]. Chinese Journal of Stroke, 2013, 8(02): 133-137.

参考文献

梁长虹, 赵振军. 多层螺旋CT血管成像[M]. 北京:人民军医出版社, 2008:74-84.

王文志. 中国脑血管病防治研究现状和发展方向[J]. 中国现代神经疾病杂志, 2011, 11:134-137.

Molina CA, Saver JL. Extending reperfusion therapy for acute ischemic stroke:emerging pharmacological, mechanical, and imaging strategies[J]. Stroke, 2005, 36:2311-2320.

Gonzalez RG. Imaging-guided acute ischemic stroke therapy:From "time is brain" to "physiology is brain"[J]. AJNR Am J Neuroradiol, 2006, 27:728-735.

Wintermark M, Meuli R, Browaeys P, et al. Comparison of CT perfusion and angiography and MRI in selecting stroke patients for acute treatment[J]. Neurology, 2007, 68:694-697.

Chalela JA, Kidwell CS, Nentwich LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke:a prospective comparison[J]. Lancet, 2007, 369:293-298.

王效春, 高培毅, 林燕, 等. CT灌注原始图像与CT血管原始图像的比较影像学研究[J]. 中国卒中杂志, 2009,4:715-720.

张巍, 胡平英, 高培毅. CT灌注成像及CT血管造影在急性脑血管疾病影像诊断中的联合应用[J]. 中国康复理论与实践, 2009, 6:576-577,.

Lima FO, Furie KL, Silva GS, et al. The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion[J]. Stroke, 2010, 41:2316-2322.

Zazulia AR, Diringer MN, Derdeyn CP, et al. Progression of mass effect after intracerebral hemorrhage[J]. Stroke, 1999, 30:1167-1173.

Mizukami M, Araki G, Mihara H, et al. Extravasation of contrast media in hypertensive cerebral hemorrhage-discussion on the mode of the growth of massive hematoma and proposal of constructive surgery[J]. No To Shinkei, 1971, 23:1359-1367.

Kowada M, Matsuoka S, Ito Z, et al. Early surgical treatment of hypertensive cerebral hemorrhage with extravasation[J]. No To Shinkei, 1971, 23:1353-1357.

Wada R, Aviv RI, Fox AJ, et al. CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage[J]. Stroke, 2007, 38:1257-1262.

Becker KJ, Baxter AB, Bybee HM, et al. Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage[J]. Stroke, 1999, 30:2025-2032.

Delgado AJ, Yoo AJ, Stone MJ, et al. Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion:the spot sign score[J]. Stroke, 2009, 40:2994-3000.

Delgado AJ, Yoo AJ, Stone MJ, et al. The spot sign score in primary intracerebral hemorrhage identifies patients at highest risk of in-hospital mortality and poor outcome among survivors[J]. Stroke, 2010, 41:54-60.

Ma J, Li H, You C, et al. Accuracy of computed tomography angiography in detecting the underlying vascular abnormalities for spontaneous intracerebral hemorrhage:a comparative study and meta-analysis[J]. Neurol India, 2012, 60:299-303.

Chen F, Wang X, Wu B. Neuroimaging research on cerebrovascular spasm and its current progress[J]. Acta Neurochir Suppl, 2011, 110:233-237.

苏若为, 田新华. 颅内动脉瘤的流行病学研究进展[J]. 国际脑血管病杂志, 2008, 16:332-335.

Hui M, Dong WX, Ciceri E, et al. Early surgery of ruptured anterior circulation aneurysm based on multislice helical computerised tomography angiography[J]. Neurol Sci, 2007, 28:323-327.

Taschner CA, Thines L, Lernout M, et al. Treatment decision in ruptured intracranial aneurysms:comparison between multi-detector row CT angiography and digital subtraction angiography[J]. J Neuroradiol, 2007, 34:243-249.

Lv F, Li Q, Liao J, et al. Detection and characterization of intracranial aneurysms with dual-energy subtraction CTA:Comparison with DSA[J]. Acta Neurochir Suppl, 2011, 110:239-245.

Menke J, Larsen J, Kallenberg K. Diagnosing cerebral aneurysms by computed tomographic angiography:meta-analysis[J]. Ann Neurol, 2011, 69:646-654.

杨运俊, 陈伟建, 诸葛启钏, 等. 多层螺旋CT三维血管成像在颅内动脉瘤夹闭术后随访中的初步应用[J]. 中华放射学杂志, 2008, 42:43-46.

王山山, 冯卫华, 李晓飞, 等. 宝石能谱CT去除金属植入物伪影的实验研究[J]. 滨州医学院学报, 2011, 34:130-132, 136.

李天然, 郑春雨, 李铭山. 脑动静脉畸形的影像学表现比较分析[J]. 中国CT和MRI杂志, 2005, 3:4-7.

马睿, 周存升, 柳澄, 等. CTA对脑动静脉畸形的诊断价值[J]. 医学影像学杂志, 2002, 12:19-21.

Tan XX, Zhong M, Zheng K, et al. Computed tomography angiography based emergency microsurgery for massive intracranial hematoma arising from arteriovenous malformations[J]. Neurol India, 2011, 59:199-203.

Willems PW, Taeshineetanakul P, Schenk B, et al. The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations[J]. Neuroradiology, 2012, 54:123-131.

罗雪芬, 朱海东, 李晖. 多层螺旋CT血管造影在烟雾病中的诊断应用[J]. 现代实用医学, 2008, 8:601-602.

Sugino T, Mikami T, Ohtaki S, et al. Assessment of moyamoya disease using multidetector row computed tomography[J]. J Stroke Cerebrovasc Dis, 2012, 22[Epub ahead of print].

张素艳, 姜文祥, 桑雅荣, 等. 64层CT平扫及CTA对烟雾病诊断价值的探讨[J]. 影像诊断与介入放射学, 2009, 5:232-233.

Linn J, Ertl-Wagner B, Seelos KC, et al. Diagnostic value of multidetector-row CT angiography in the evaluation of thrombosis of the cerebral venous sinuses[J]. AJNR Am J Neuroradiol, 2007, 28:946-952.

Gaikwad AB, Mudalgi BA, Patankar KB, et al. Diagnostic role of 64-slice multidetector row CT scan and CT venogram in cases of cerebral venous thrombosis[J]. Emerg Radiol, 2008, 15:325-333.

Styblo-Sramek DI, De Temmerman G, Verbist BM. Left vein of Labbe thrombosis associated with ipsilateral dural sinus thrombosis:non-enhanced CT and contrast-enhanced CT(CTV) findings[J]. JBR-BTR, 2012, 95:226-228.

Gratama VAH, van Boven LJ, van Walderveen MA, et al. Interobserver variability in the detection of cerebral venous thrombosis using CT venography with matched mask bone elimination[J]. Clin Neurol Neurosurg, 2009, 111:717-723.

姜兴岳, 姚振威, 耿道颖, 等. 十六排螺旋CT血管造影对颅内病变的应用价值初探[J]. 中国医学计算机成像杂志, 2003, 9:393-397.

吴劲松, 陈爽, 毛颖, 等. 3D-CT/3D-CTA在神经外科领域的应用研究[J]. 中国微侵袭神经外科杂志, 2001, 6:221-226.

Kasuya H, Matsumoto M, Munakata R, et al. Separate demonstration of arterial-and venous-phase by 3D-CT angiography for brain tumors using 64-multidetector row CT:3D-CT arteriography and 3D-CT venography[J]. Fukushima J Med Sci, 2009, 55:7-22.

姜保东. CT静脉造影在脑内疾病诊断和治疗中的应用[D]. 复旦大学, 2006.

高思佳, 石强, 王强, 等. 多层螺旋CT脊髓血管成像的初步研究[J]. 中华放射学杂志, 2007, 41:345-347.

高思佳, 章梦薇, 朱玉森, 等. 64层螺旋CT脊髓血管造影诊断脊髓血管畸形的临床应用研究[J]. 中国临床医学影像杂志, 2008, 6:415-418.

杨延辉, 李坤成, 刘亚欧, 等. 64层螺旋CT血管成像诊断脊髓血管畸形的价值[J]. 中华放射学杂志, 2009, 43:38-41.

石强, 高思佳, 徐克, 等. 64层螺旋CT血管成像定位诊断硬脊膜动静脉瘘供血动脉及瘘口的应用初探[J]. 中国医学影像技术, 2006, 22:1532-1534.

曹际斌, 高思佳, 韩鹏, 等. 256层螺旋CT全脊髓血管造影诊断脊髓动静脉瘘的临床价值[J]. 中国临床医学影像杂志, 2012, 23:91-95.

Sakai Y, Matsuyama Y, Imagama S, et al. Clinical utility of multidetector row computed tomography for diagnosing spinal dural arteriovenous fistulas undiagnosed by magnetic resonance imaging[J]. Geriatr Gerontol Int, 2010, 10:255-263.

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