| PrefaceVirtual vascular 3D - CT endoscopy is a recently developed imaging modality. 3D images of this technique (include Fly -around and Fly - through) were obtained using a new processing technique which extracts CT number in the boundary region between the vessel wall and contrasts media filled in the vascular lumen. Clinical application of this technique to cerebral aneurysms, particularly to complicated large cerebral aneurysms showed that, with this virtual vascular 3D - CT endoscopic imaging, anatomical details of cerebral aneurysms such as the orifice of the aneurysm^the neck of the aneurysm and intraluminal thrombus could be demonstrated clearly. Using a 3 - D imaging method by Helical CT, virtual views of various surgical approaches were compared preoperatively. But its diagnostic value alone in the cerebral aneurysms was less studied. In this retrospective study, we evaluated the diagnostic value and clinical significance of virtual vascular 3D -CT endoscopy as a method for cerebral aneurysms in patients with spontaneous subarachnoid hemorrhage.Materials and methods1. MaterialIn present study, 46 patients(29 men, 17 women, age 17 to 69 years, mean age 45.3 ± 13. 0 years) who presented with spontaneous SAH, underwent both 3D - MSCTA and DSA. 29 patients of them accepted surgical clipping, and 2 patients of them accepted endovasular embolization.2. MethodRow data was acquired by Multi - slice helical CT - AQUILION (Toshiba) : The scan speed 0.5s/rot, image slice thickness 1.0mm, helical pitch 3.0/5.0 . Contrast media (Angiografin) was injected intravenously (1.0 - 2. 0ml/kg) at speed of 2. 5 - 3. 0ml/s, delay time was 15 - 23s, reconstruction interval 0. 5mm, reconstruction slice thickness 1.0mm. Source images were processed using a workstation SGI - 02, images post - processing software was ALATO-VIEW, version 1.21. The reconstructed images were then processed into SVR, MPR, Fly - around and Fly -through images. Entire brain DSA was performed obtaining anterioposterior, lateral, and oblique images. Images of 3D - MSCTA and DSA were analysed by 2 radiologists and 2 neurosurgeons, with assessment of 3 D - MSCTA and DSA finding respectively.ResultsA total of 39 aneurysms were detected in 37 patients by Fly - a-round image and were confirmed by DSA and/or operation method (true positives). 35 patients sustained single aneurysm, 2 patients sustained two. In one case, two aneurysms were defected by DSA andconfirmed by surgery, but only one was demonstrated by Fly - around image (false negative). The presence of cerebral aneurysms was excluded at SVR and Fly - around and DSA in 9 patients (true negatives). There were no false positives. The mean maximal diameter of aneurysms body was 6. 21 ±4. 33mm. Sensitivity was 98% , Specificity was 100% , diagnostic accuracy was 98% .37 aneurysms were demonstrated and 3 aneurysms were no detected by SVR.DSA revealed 38 aneurysms in 37 patients, 35 patients sustained one aneurysm, 3 patients sustained two. 2 single aneurysms were not detected. The mean maximal diameter of aneurysms body was 6.15 ± 4. 29mm. There was not statistic differences between the measurement of Fly - around and DSA about the size of the aneurysm body (t = 1. 42 ,P >0. 05). The finding rate of the aneurysms of Fly - around and SVR and DSA was 98% ,93% and 95% , respectively. There were no statistic differences among them.Intraluminal thrombus was detected in 6 singe aneurysms by virtual vascular 3D - CT endoscopy ( Fly - through) and confirmed by MPR.Discussion1. The value of virtual vascular 3D - CT endoscopy in the detection and evaluation of aneurysms.The common reasons of SAH is ruptured cerebral aneurysms. The mortality remains 36% -45% in the early stage of the illness. So it is important to diagnose early. The effective treatment is surgical clipping or endovasculax embolization of cerebral aneurysms. DSA was regarded as the gold standard of diagnosis in the cerebral aneurysms,but it is an invasive method. As a rapid and non... |
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