The Study Of Application Of Multi Spiral CTA For Diagnosing And Treating Anterior Communicating Aneurysms

The rupture of intracranial aneurysm is one of the major causes of spontaneous subarachnoid hemorrhage (SAH). Anterior communicating aneurysms, which is the first place of incidence rate and accounts for 1/3 of intracranial aneurysms, may cause repeated bleeding, result in high death and mortality rate. Therefore, the accurate diagnosis and treatment of anterior communicating aneurysms at early stage is highly important. With the rapid development of CTA technology, multi-spiral CTA is brought forward which can be used in the diagnosis of intracranial aneurysm with high accuracy, speciality and sensitivity. This research reviewd the CTA materials of 70 patients of anterior communicating aneurysms both before and after operation (of which 46 patients with anterior communicating aneurysms used clips to close the aneurysms). The aim of this research is to application of CTA for the anterior communicating aneurysms, thus providing exact reference for the diagnosis and treatment of the disease and evaluating the postoperative efficiency.Methods:this research collected the CTA image data of 70 cases of preoperative and postoperative anterior communicating aneurysms. Among them,46 cases used the same kind of aneurysm clip(type:Yasargils, FT750T; made in titanium). All the cases were treated with Siemens dual-source CT scan (slice thickness 0.625mm,1.375 pitch, scanning speed 0.8s/turn, the current 250-350mA.). In all the cases, high-pressure injectors were used to inject contrast agents through elbow veins, with the volume of contrast agents being 1.5ml/kg, bolus injection rate being 3-4ml/s, delay time generally being 16-20s, from the base of the skull to the cranial vault. Row image datas were processed through GE Adw 4.2 station with maximal intensity projection and volumn rendering etc.We compared the MIP and VR images of the width and length of clips and length of clip tips with the actual Yasargils in the 46 cases of postoperative anterior communicating aneurysms, which used the same aneurysm clip in the 70 cases of anterior communicating aneurysms. And we use SPSS 13.0 to make t statistical test and Fisher's exact test and Spearman correlation,If P<0.05, it bears statistical importance.The results:1.The 70 cases of anterior communicating aneurysms cause hemorrhagic classification of SAH:24 cases presented the hemorrhagic classification 1,14 cases presented the hemorrhagic classification 2,25 cases presented the hemorrhagic classification 3, and the 7 cases presented the hemorrhagic classification 4.Hemorrhagic classification was different with Hunt-Hess (P=0.036, p<0.05), and the Spearman correlation (r=0.289, P=0.014, p<0.05) was also discovered.2.The 70 cases of anterior communicating aneurysms have the classification of blood flow of horizontal segment Al model:22 cases presented model 1,16 cases presented model 2,and 32 cases presented model 3.Model land 2 belong to the A1 dominant signs,that accounted for the total (70cases) 54.3%, and Left-side dominance was 3.75 times than Right-side. That result indicates the significant correlation between the A1 dominant signs and ACoAA, and Left-side dominance is more clearly than Right-side.3.The 70 cases of postoperative information of anterior communicating aneurysms use 81 clips with different type(FT740T,FT637T,07-934-01 etc),the 11 cases of them used 2 clips in operation, and the 46 cases of them used the clips with the same type,that was in accordance with the record of operation.4.The sizes of Yasargils measured through CTA-MIP and VR both disparated from the actural sizes(p<0.05). The magnification rates of Yasargils by MIP and VR images can be roughly calculated through the formula:MIP magnification rate≈0.116; VR magnification rate≈0.228. Conclusions:1.CTA can clearly show the shape of hemorrhagic classification of anterior communicating aneurysms, which is to surgical doctor about the direct reference of amount of bleeding which ACoAA causing SAH; 2. CTA can distinctively show the A1 dominant signs of anterior artery, which are the significant correlation with the formation of ACoAA, and Left-side dominance is more clearly than Right-side;3. CTA can evaluate the postoperative efficiency, which is the meaningful action;4.Through roughly calculation, the magnification rate of aneurysm clip by CTA can be deduced, so as to provide the magnification rate of ACoAA.This is important for providing more accurate size of ACoAA and choosing out the suitable treatment programs as well as improve the success rates of surgery.