The Value Of Cerebral Blood Vessel Imaging In The Diagnosis Of Intracranial Aneurysm In Emergency Room

Background and object:Intracranial aneurysm refers to the local dilatation of the intracranial arterial vessel.The ruptures of the aneurysm are the mostly causes of SAH(subarachnoid hemorrhage),and this kind of SAH is associated with significant mortality of about 42%-50%.Then the key of curing is early diagnosis and early therapy.Digital subtraction angiography is regarded as the golden criterion of the diagnosis,but is traumatic,time costing,contrast agents needed,and sometime serious complications.Recently more and more clinicians begin to pay attention to non-traumatic imaging method.Here the 3D-SCTA,DSA and MRA data of 36 cases of intracranial aneurysm hemorrhage,were restrospectively collected to evaluate the screening value of the imaging method,and offer foundation to more research.1.1.object and method:1.1.1 general data:The 3D-SCTA,DSA and MRA data of thirty-six cases of intracranial aneurysm hemorrhage admitted in our hospital during April 2005 to December 2006,were restrospectively collected male 14 cases,female 22 cases,aging from 26 to 75,average 48.3.1.1.2 clinical manifestation:SAH 33 cases,SAH complicated with cerebral hemorrhage 3 cases, single oculomotor nerve palsy 16 cases,sight declining,headache, swirling 31 cases,consciousness obstacle 12 cases,limb paralysis 8 cases.The Hunt-Hess grade of admitting:degreeⅠ,12 cases,degreeⅡ,12 cases,,degreeⅢ,6 cases,degreeⅣ,4cases,degreeⅤ,2 cases.1.1.3 Statistics method: Compare the sensitivity,specificity and accuracy of 3D-SCTA, 2D-DSA,3D TOF-MRA to the number,neck and important perforating branches of all results were compare to the finding during operation too. rowxcolumn table data X~2 analysis was employed,P＜0.05 was regarded as having significant difference.SPSS12.0 software was used for the statistical analysis.1.2 Result:1.2.1 One cases with no aneurysm was found,44 aneurysms in 3D-SCTA imaging was found,45 aneurysms in 2D-DSA imaging was found,44 aneurysms in 3D TOF-MRA imaging was found.2 cases were faulse negative in 3D-SCTA,1 case was faulse negative in 2D-DSA,6 cases were faulse negative in 3D TOF-MRA.1.2.2 Compare the specificity and sensitivity to 3D-SCTA,2D-DSA and 3D TOF-MRA,X~2 analysis was employed,the difference was not significant(X~2values were 0.006,2.581,P＞0.05).1.2.3 Compare the imaginging efficiacy to the locations and three dimensional details of aneurysm,the difference of the three methods according to X~2analysis was not significant.X~2=4.2572,P＞0.05.1.2.4 Compare the imaginging efficiacy to the important perforating branches of the aneurysm,the difference of the three methods according to X~2 analysis was significant.X~2=33.8205,P＜0.01.1.3 Conclusion:1.3.1 3D-SCTA is a non-traumatic,economic,rapid and convenient method in cerebral blood vessel imaging,and has superiority in showing the position,magnitude,direction,neck,the three dimensional space relationship with close blood vesse,basis cranii and other aneurysm-bearing artery.It can be the first-line method in emergency screening and following-up of patients with intracranial aneurysm.1.3.2 2D-DSA is non-third dimensional,traumatic,costing, operation-complicated,and sometime induce bleeding and blood vessel spasm,but it has superiority in showing important perforating branches of the aneurysm and the blood direction of instant aneurysm-bearing artery,so it can be the contrasting screening method of suspicious complicated aneurysm. 1.3.3 3D TOF-MRA needs no radiation and contrast agent,and is not effected by intravascular thrombus and sinus,but it is time-costing and need compliance of patients.It is not fit for emergency and the patients who bearing intracranial metal foreigner. The photo is effected by blood speed and intravascular thrombus. 3D TOF-MRA has high faulse negative rate,and can not show cranial bone.1.3.4 The three methods have the superiority and shortage of themselves,can be combined and achieve best diagnostic purpose.