CAJ | 학술논문

目的：探讨三维数字减影血管造影（3D-DSA）对破裂颅内动脉瘤夹闭术后残留的评估价值。方法：回顾性分析2011年1月至2012年12月术后均采用3D-DSA 和普通造影对破裂颅内动脉瘤夹闭术后复查的患者88例，动脉瘤数92个，行3D-DSA 后分别应用最大密度投影（MIP）、容积成像（VR）、梯度成像（GR）重建图像，评价术后残留，瘤夹显影，载瘤动脉与瘤夹关系，载瘤动脉有无狭窄。结果：动脉瘤夹闭总数92个，术后残留23个（25．0％），根据Sindou分级，Ⅰ级15个，Ⅱ级3个，Ⅲ级4个，Ⅳ级1个。其中Ⅲ级残留患者再次手术3例，Ⅳ级残留再次手术1例，Ⅲ级残留未手术，再出血1例。 VR、GR、MIP 重建图像均可明确显示瘤夹及个数，载瘤动脉与瘤夹关系，VR、GR可清楚显示动脉瘤残留。VR、GR、MIP在载瘤动脉瘤狭窄上存在较大局限，需结合普通DSA做出准确判断。结论：3D-DSA可准确评估破裂颅内动脉瘤夹闭术后残留，特别是VR、GR重建技术更易于显示动脉瘤残留，有助于指导术后随访。
목적：탐토삼유수자감영혈관조영（3D-DSA）대파렬로내동맥류협폐술후잔류적평고개치。방법：회고성분석2011년1월지2012년12월술후균채용3D-DSA 화보통조영대파렬로내동맥류협폐술후복사적환자88례，동맥류수92개，행3D-DSA 후분별응용최대밀도투영（MIP）、용적성상（VR）、제도성상（GR）중건도상，평개술후잔류，류협현영，재류동맥여류협관계，재류동맥유무협착。결과：동맥류협폐총수92개，술후잔류23개（25．0％），근거Sindou분급，Ⅰ급15개，Ⅱ급3개，Ⅲ급4개，Ⅳ급1개。기중Ⅲ급잔류환자재차수술3례，Ⅳ급잔류재차수술1례，Ⅲ급잔류미수술，재출혈1례。 VR、GR、MIP 중건도상균가명학현시류협급개수，재류동맥여류협관계，VR、GR가청초현시동맥류잔류。VR、GR、MIP재재류동맥류협착상존재교대국한，수결합보통DSA주출준학판단。결론：3D-DSA가준학평고파렬로내동맥류협폐술후잔류，특별시VR、GR중건기술경역우현시동맥류잔류，유조우지도술후수방。
Objective To assess the application of three-dimensional digital subtraction angiography (3D-DSA) in evaluation of ruptured intracranial aneurysm after clipping and to discuss the different variable use of vol-ume rendering(VR), gradient rendering (GR) and maximum intensity projection (MIP). Methods From January 2011 to December 2012 , 88 patients with 92 ruptured intracranial aneurysms were treated with clipping using titani-um clips in our hospital and followed up by both 2D-DSA and 3D-DSA. Residual aneurysms , Clips place, clips and parent arteries and stenosis of parent arteries were evaluated by volume rendering (VR), gradient rendering (GR) and maximum intensity projection (MIP). Results Among 92 clipped aneurysms, 23 residual aneurysms were found by 3D-DSA. Residual aneurysms were recorded according to the Sindou grade: 15 of gradeⅠ, 3 of gradeⅡ, 4 of grade Ⅲand 1 of grade Ⅳ. Three patients of grade Ⅲand 1 of grade Ⅳwith residual aneurysms were retreated by clipping or coiling, and 1 patient of grade Ⅲ was dead with rupture of residual aneurysm. The clips and number of clips were clearly visualized , and relationship between the clips and the aneurysms was well demonstrated by VR, GR and MIP images. VR, GR images showed the remnants clearly. Three-dimensional digital subtraction angiography did not showed accurate details of the stenosis of parent arties which required an analysis of 2D-DSA. Conclusion Three-dimensional digital subtraction angiography can be used for definite evaluation of resid-ual aneurysms after clipping, especially by VR, GR images. It is helpful to manage the residual ruptured aneurysms.