Study Of Multiplanar Spiral Computer Tomography Angiography In Intracranial Ruptured Aneurysms Among Chinese

Objectives:This thesis aims to study comparatively the diagnosis, image quality and safety of the multi-slice CT (16-slice spiral CT, dual source spiral CT) angiography in the Chinese ruptured intracranial aneurysm; to comprehensively analyze the epidemiology of intracranial aneurysm rupture and imaging features; to summarize rupture factors, bleeding patterns and at the time to discuss the clinical value of the multi-slice CTA in the ruptured aneurysm treatment alternatives and in the postoperative evaluation of the aneurysm clip itself, the parent artery and the clipping distal aneurysms.Materials and Methods:1. Patients, suffered from SAH or intracranial hematoma, who were suspected or once confirmed as AN from January 2007 to April 2010 in the First Hospital of Jilin University underwent the16-slice and dual-source CTA check. The cases confirmed by surgery and DSA were enrolled in this study, including 897 patients with aneurysms.2. CTA examination methodsThe GE light speed 16-slice spiral CT and dual-source CT spiral CT on the circle of Willis 0.6sec Full mode and Head angiography routine scan sequence were applied. The Omnipaque or Ultravist were injected by high-pressure syringe: total dose: 60-90ml; injection speed : 3.0-4 .0 ml / s; delay time :16-21s.3. CTA three-dimensional image processingThe raw data were transferred to GEAdw4.2 and SIMENS workstations, the images were reconstructed using maximum intensity projection, volume rendering technology and multi-planar reconstruction (MPR) technique. The image qualities were then scored and compared according to different levels.4. Research methodsThis thesis comparatively analyzed the two multi-slice CT's value and safety in diagnosing the Chinese ruptured intracranial aneurysms; it conducted a correlation and constituent ratio analysis about the epidemiology and imaging features of ruptured intracranial aneurysms respectively; it retrospectively evaluated the postoperative clinical value of multi-slice CTA in the ruptured intracranial aneurysms.5. Statistical methodsSPSS 10.0 statistical analysis software for data processing was used. Measurement data was expressed by±s; the comparative of samples between two groups adopted t test; the constitute ratio of count data among groups and the comparison of sample rate both employχ2 test.Results:1. The overall diagnostic ratio of MSCTA in testing ruptured intracranial aneurysms was 98.77%; the diagnostic ratio of 16MSCT in testing ruptured intracranial aneurysms was 98.77%; and that of dual-source MSCT was 99.20%; there was no statistical significance in the differences between the diagnostic ratios of these two kinds of equipment. There were no statistical differences between the VR reconstructions of these two kinds of equipment for displaying the comparative analysis of image quality of the aneurysmal neck. 2. The dose of angiography used for testing intracranial aneurysms by 16MSCTA and double-source 16MSCT were on average 67ml, 88ml respectively. The difference was quite obvious. The accepted radiation doses(DLP mGy-cm)for testing intracranial aneurysms by 16MSCTA and double-source 16MSCT were on average 1128.7 and 648.6 respectively. The difference between the two was obvious.3. The statistical results of the epidemiology of Chinese ruptured intracranial aneurysms were: the most common site was the bifurcation of the great vessels and the anterior communicating artery aneurysm ranked the first; the most common age ranged from 50-59; it significantly increased more in women than in men, and showed a positive correlation with age.The statistical results of imaging features of Chinese ruptured intracranial aneurysms were: the length-diameter of the tumor that is the most vulnerable to rupture was 3-10mm; the form of the aneurysm that is the most vulnerable to rupture were lobulated, finger, cystic and hummocky in turn; The ruptured aneurysm occurred at anterior communicating artery showed a positive correlation with the advantages of blood in A1 segment of the anterior artery.The intracranial hemorrhage caused by ruptured aneurysms at different sites showed the following features: SAH caused by anterior communicating artery aneurysms had a large amount of bleeding and the bleeding pattern mainly was extensive SAH with varying degrees of intracerebral hematoma and intraventricular hemorrhage; the amount of bleeding caused by posterior communicating artery aneurysms was significantly less than that caused by anterior communicating artery aneurysms and the main bleeding patterns were limited and extensive subarachnoid hemorrhage; SAH caused by 70-80% posterior communicating artery aneurysms with a 5-7mm tumor diameter was not associated with intraventricular hemorrhage and intracerebral hematoma; the bleeding pattern caused by middle cerebral artery bleeding mainly were limited and extensive SAH with limited hematoma. The ruptured middle cerebral aneurysms with a 5-7mm tumor diameter were consistent with this bleeding pattern. There was no obvious correlation between the bleeding patterns caused by aneurysm rupture at different sites and the form of aneurysm.4. There were no statistical differences in the comparative analysis of 16MSCTA and double-source MSCT in the postoperative evaluation of clipped intracranial aneurysm, parent artery and distal blood supply.Conclusions:1. The application of Multi-slice Spiral CT to intracranial aneurysms surgery has a very important clinical value. It can be used as the intracranial aneurysms routine examination in the suspected cases. By comparison of 16-slice CT and dual source CT, it is found that both of them have high diagnostic value. Dual source CT is slightly better than 16-slice CT, but there are no statistical differences. At the same time of meeting the diagnostic requirements, the dose of angiography of dual-source CTA is significantly lower than 16MSCT and the accepted radiation doses in CTA testing is significantly lower than 16MSCT.2. Ruptured intracranial aneurysms happen more likely to women than to men. Moreover, with the growth of age, women have a higher incidence. The high incidence of age ranges from 50-59. Multi-slice spiral CTA observes that the reference factors causing intracranial aneurysms are: tumor diameter ranges from 3-10mm; the form of tumor is similar to cystic and finger-shaped; the angle between the axis of tumor and that of parent artery is obtuse angle.Intracranial hemorrhage caused by intracranial aneurysms ruptured at anterior communicating artery, posterior communicating artery, and middle cerebral artery shows different features. According to the bleeding patterns displayed by CT scan, it can be judged preliminarily the sites of ruptured aneurysms. The bleeding patterns caused by ruptured aneurysms at posterior communicating artery and middle cerebral artery have certain rules. There is no obvious correlation between the bleeding pattern caused by ruptured aneurysms at different sites and the form of the tumor.3. The diagnostic information provided by 16 MSCTA and dual-source MSCTA can guide the ruptured aneurysm treatment alternatives and the surgical approach, meanwhile it has a significant diagnostic meaning in the visit after the aneurysm surgery.