本文選題：顱內(nèi)動脈瘤 + 體層攝影術(shù)��； 參考：《青海大學(xué)》2012年碩士論文

【摘要】：目的：對顱內(nèi)動脈瘤破裂與多層螺旋CT血管造影（MSCTA）相關(guān)因素進行分析，預(yù)測動脈瘤破裂的風(fēng)險。 方法：回顧性收集2010年4月-2012年2月在青海大學(xué)附屬醫(yī)院影像中心48例自發(fā)性蛛網(wǎng)膜下腔出血的患者及18例未出現(xiàn)蛛網(wǎng)膜下腔出血的患者行MSCTA均診斷為顱內(nèi)動脈瘤，男性30例，女性36例，男：女=0.83：1，，年齡30-72歲，平均年齡52.76±11.48歲。所有患者均通過Philips Brillance16排及256層螺旋CT進行顱內(nèi)MSCTA掃描（1）16排CT掃描條件為管電壓120KV,管電流300mA，層厚0.8mm，層距1mm，螺距1，矩陣512x512，造影劑注射速度為4.0-4.2ml/s，總量約60-80ml（2）256層CT掃描條件為管電壓120KV，管電流250mA，層厚0.9mm，層距0.5，螺距0.825，矩陣512x512，掃描時注藥速度5.0ml/s，總量40-50ml；患者仰臥位，雙手于身體兩側(cè)，右手臂接注射針，囑患者放松，進行定位像掃描，取示蹤點于主動脈弓，設(shè)置觸發(fā)閾值為120HU，然后選取主動脈弓至顱頂為掃描范圍，當(dāng)主動脈弓取點CT值達到120HU時，自動掃描，產(chǎn)生的重建圖像傳送到Extended Brilliance Workspace2.0（16排）、4.5（256層）工作站處理，在后處理工作站上測量動脈瘤的各項參數(shù)、部位、形態(tài)特征等，比較它們在破裂動脈瘤與未破裂動脈瘤中的差異。 結(jié)果：（1）66例患者共發(fā)現(xiàn)動脈瘤78個，其中256層有10例患者13個動脈瘤，其余在16排；未破裂動脈瘤30個,動脈瘤長徑10mm的26個，破裂動脈瘤48個，10mm的41個，其中有4個有子囊；40-65歲之間的45個，40歲的10個，65歲的11個；（2）動脈瘤位于血管分叉處的共45個，其中32個發(fā)生破裂，13個未破裂；位于血管未分叉處的33個，其中破裂的16個，未破裂的17個，血管分叉處與未分叉處動脈瘤破裂比較差異有統(tǒng)計學(xué)意義（X2=4.122，P0.05）；（3）通過排除，對49個動脈瘤進行瘤體長短、瘤頸測量并瘤體長/瘤頸、瘤體寬/瘤頸寬比值進行比較，破裂與未破裂組分為所有的動脈瘤組（ALL）及動脈瘤長徑10mm組，在ALL及長徑10mm中：瘤體長、短徑及瘤頸寬在兩組中的差異沒有統(tǒng)計學(xué)意義（P0.05）,破裂組與未破裂組瘤體長/瘤頸寬比值為2.13±0.83、1.63±0.51，兩者差異有統(tǒng)計學(xué)意義（t=2.375，P0.05）,破裂組與未破裂組瘤體寬/瘤頸寬比值為1.63±0.66，1.29±0.38，兩組差異有統(tǒng)計學(xué)差異（t=2.103，P0.05）；在動脈瘤長徑10mm中：破裂組與未破裂組瘤體長/瘤頸比值為1.93±0.59、1.54±0.31，兩組差異有統(tǒng)計學(xué)差異（t=2.634，P0.05）,而破裂組與未破裂組瘤體寬/瘤頸寬比值為1.49±0.51、1.23±0.30，兩組差異沒有統(tǒng)計學(xué)差異（t=1.945，P0.05）。 結(jié)論：動脈瘤發(fā)生部位、動脈瘤體長徑與瘤頸寬之比、動脈瘤體寬徑與瘤頸寬之比是動脈瘤可能破裂的危險因素，且差異有統(tǒng)計學(xué)意義。
[Abstract]:Objective: to analyze the related factors of intracranial aneurysm rupture and multislice spiral CT angiography (MSCTA) to predict the risk of aneurysm rupture. Methods: from April 2010 to February 2012, 48 patients with spontaneous subarachnoid hemorrhage and 18 patients without subarachnoid hemorrhage in the imaging center of the affiliated Hospital of Qinghai University were examined for intracranial aneurysms diagnosed by MSCTA, including 30 males. 36 cases were female (male: 0.83: 1), aged 30 to 72 years, with an average age of 52.76 鹵11.48 years. All patients underwent intracranial MSCTA scan with Philips Brillance16 slice and 256-slice spiral CT. The CT scan conditions were as follows: tube voltage 120 kV, tube current 300 Ma, slice thickness 0.8 mm, pitch 1, matrix 512 x 512, contrast media injection rate 4.0-4.2 ml / s, total CT scanning condition about 60-80ml(2)256 slice. For voltage 120kV, current 250 Ma, layer thickness 0.9 mm, pitch 0.5, pitch 0.825, matrix 512x512, injection speed 5.0 ml / s, total 40-50 ml, patient supine position, With both hands on both sides of the body, the right arm was followed by a needle injection, and the patient was told to relax, scan with a localization image, trace points to the aortic arch, set a trigger threshold of 120 HU. then select the aortic arch to the top of the skull as the scanning range. When the CT value of aortic arch reached 120HU, the reconstructed image was transferred to the Extended Brilliance Workspace2.0(16 row 4.5 / 256) workstation. The parameters, position and morphological features of aneurysm were measured on the post processing workstation. To compare their differences between ruptured and unruptured aneurysms. Results A total of 78 aneurysms were found in 66 patients with 1 / 66 cases, including 10 patients with 13 aneurysms in 256-layer, 30 unruptured aneurysms, 26 aneurysms with long diameter 10mm and 41 ruptured aneurysms with 10 mm long diameter aneurysms. Of these, 4 had 45 cysts between 40 and 65 years of age, 10 patients aged 40 to 65 years old, 11 patients aged 65 years old, 45 aneurysms located at the branches of blood vessels, 32 of them ruptured, 13 of them unruptured, and 33 of them were located at unbroken vessels, of which 16 were ruptured. There were significant differences in rupture of aneurysms between unruptured and unruptured aneurysms (X24.122 / P0.05). Through exclusion, 49 aneurysms were compared in tumor length, tumor neck length / neck length, tumor width / tumor neck width ratio. Ruptured and unruptured components were all aneurysm group (ALL) and aneurysm long diameter 10mm group, in ALL and long diameter 10mm: tumor length, There was no significant difference in short diameter and neck width between the two groups (P 0.05). The ratio of tumor length to neck width in ruptured group and unruptured group was 2.13 鹵0.83n 1.63 鹵0.51.The difference was statistically significant. The ratio of tumor width to neck width in ruptured group and unruptured group was 1.63 鹵0.66n1.29 鹵0.38, respectively. The ratio of tumor length to neck in ruptured group and unruptured group was 1.93 鹵0.59 鹵1.54 鹵0.31, there was statistical difference between the two groups, and the ratio of tumor width to neck width in ruptured group and unruptured group was 1.49 鹵0.51g / 1.23 鹵0.30.The difference between the two groups was statistically significant (t = 2.103, P 0.05), and the ratio between ruptured group and unruptured group was 1.49 鹵0.51g / 1.23 鹵0.30, and the ratio between ruptured group and unruptured group was 1.49 鹵0.51g / 1.23 鹵0.30. There was no statistical difference between the two groups. Conclusion: the location of aneurysm, the ratio of length to width of aneurysm and the ratio of width of artery to width of neck are the risk factors of possible rupture of aneurysm, and the difference is statistically significant.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R816.2;R743

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