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研究生:洪嘉亨
研究生(外文):Chia-Heng Hung
論文名稱:三維旋轉血管造影術評估顱內微小動脈瘤的應用
論文名稱(外文):The Application of Three Dimensional Rotation Angiography in Evaluation of Intracranial Micro-Aneurysms
指導教授:劉宏智
指導教授(外文):Hong-Chih Liu
學位類別:碩士
校院名稱:元培科技大學
系所名稱:放射技術研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
畢業學年度:99
語文別:中文
論文頁數:64
中文關鍵詞:蜘蛛膜下腔出血三維旋轉血管造影術顱內微小動脈瘤
外文關鍵詞:SAH3DRAIntracranial Micro-Aneurysms
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研究背景:腦血管疾病是國人健康的大敵,除了是前三大死因外,更是青壯年人口失能與殘障的一大主因;而且其嚴重性隨著國內老年人口增加,有上升的趨勢。而最常見的腦血管疾病就是顱內動脈瘤破裂所導致的蜘蛛膜下腔出血(Subarachnoid Haemorrhage, SAH)。SAH死亡率極高,即便存活病患也往往留下嚴重後遺症。因此積極控制或治療前述的致病因素最直接的作法就是找出顱內動脈瘤所在位置,施以適當的處置,以防範未然。
研究目的:探討利用三維旋轉血管造影術(Three Dimensional Rotation Angiography,3DRA)來評估診斷顱內微小動脈瘤患者的診療價值。
研究方法:2007年4月至2010年12月間共有61位疑似有顱內動脈瘤的病患(35位女性,26位男性);其年齡範圍在23-88歲之間,平均年齡為55.2歲。所有病患皆接受3DRA及三維重組影像以評估顱內動脈瘤之位置、大小、外型結構及其與鄰近血管的解剖相互關係。
結果與結論:在61個患者中總共發現76個顱內動脈瘤。3DRA功能只需單次注射對比劑、單次檢查即可多角度顯示病變。3DRA在輻射劑量和對比劑用量均較傳統DSA降低。對於顱內微小動脈瘤及其他顱內血管病變3DRA皆能夠立體、直觀清楚地顯示全面詳細的解剖信息,尤其是對血管解剖結構複雜的病例。它能非常清晰地顯示動脈瘤體部大小、生長方向、動脈瘤頸的寬窄與長短、供血動脈與動脈瘤及鄰近血管之間的解剖關係、提供血管內治療的最佳工作角度、精確測量動脈瘤的大小。從而有利於治療計劃制定及選擇;為外科手術或顱內動脈瘤血管內栓塞治療及血管內支架置入術的成功提供了保障;也降低了併發症的發生;是顱內動脈瘤栓塞治療和術後追蹤的有力工具。
Background: Cerebrovascular disease is a huge health impact for general population in Taiwan. It is the top three leading causes of death [1] and contributes to the major cause of disabilities in young population. It has been observed that the severity of the disease increases with the growing of the elderly population. One of the most common cerebrovascular disease is the subarachnoid hemorrhage (SAH) caused by the intracranial aneurysms rupture. Aneurysmal SAH is associated with high mortality rate and severe sequela even if the patient is survived from the incidence. The primary prevention for aneurismal SAH is focused on the detection of the unruptured intracranial aneurysms and appropriate management after throughout evaluation.
Purpose: To evaluate the clinical significance of assessing the intracranial micro-aneurysms by using the three-dimensional rotational angiography (3DRA).
Methods: From April 2007 to December 2010, a retrospective review of medical records and radiologic images revealed 61 patients (35 women; 26 men) suspected to be the victims of the intracranial aneurysms. Their age ranged from 23 to 88 years old with a mean of 55.2 years. All patients underwent the 3DRA with three-dimensional reconstruction for assessing the location, size and shape of the intracranial micro-aneurysms and the anatomical relations with the adjacent vascular structures.
Results and Conclusion: A total of 76 intracranial aneurysms were found in the 61 patients. The advantage of the 3DRA is providing the multiplanar reconstruction display of the target lesion by using single injection of the contrast medium in single study. The total amount of the radiation dosage and the contrast agent injection in the 3DRA is much lower than the conventional DSA. For the intracranial micro-aneurysms and other vascular lesions, the detailed anatomical information include the size of the aneurysm sac, growth direction, the neck width and length can be clearly demonstrated in the 3DRA, especially for the complex lesions. Furthermore, the 3DRA can provide the optimal working plane for the endovascular treatment and therefore contribute to the appropriate treatment planning. The 3DRA not only raises the success rate of the surgical and endovascular treatment for the intracranial aneurysms but also lowers the complication rate and has become an important image modality in post-treatment follow up.
中文摘要…………………………………………………………………… I
英文摘要 ………………………………………………………………… II
致謝函 …………………………………………………………………… IV
目錄…………………………………………………………………………V
圖目錄… ………………………………………………………………… VII
表目錄 …………………………………………………………………… IX
第一章 緒論 …………………………………………………………… 1
1.1 前言…………………………………………………………………………1
1.2 文獻回顧 ………………………………………………………………… 5
1.3 研究背景 ………………………………………………………………… 7
1.3.1 血管造影術原理………………………………………………………8
1.3.2 數位減影血管造影術原理…………………………………………… 8
1.3.3 三維旋轉血管造影術原理………………………………………… 11
1.4 研究目的 …………………………………………………………………14
1.5 研究方法與步驟 …………………………………………………………15
1.6 預期成果 ……………………………………………………………16
第二章 基礎理論………………………………………………………17
2.1 顱內血管的結構 ……………………………………………………… 17
2.2 顱內動脈瘤的簡介………………………………………………………19
2.3 顱內動脈瘤的病因及症狀………………………………………………20
2.3.1 蜘蛛膜下腔出血的徵象和症狀……………………………… 21
2.4 治療方法…………………………………………………………………22
2.4.1 外科手術治療………………………………………………… 23
2.4.2 血管內線圈治療……………………………………………… 24
第三章 研究方法……………………………………………………… 28
3.1 臨床資料…………………………………………………………… 28
3.2 設備與器材………………………………………………………… 30
3.2.1 設備…………………………………………………………… 30
3.2.2 器材…………………………………………………………… 30
3.2.3 對比劑………………………………………………………… 30
3.3 檢查方法…………………………………………………………… 30
3.3.1 常規DSA腦部血管造影……………………………………… 30
3.3.2 3DRA血管造影…………………………………………………33
3.4 3DRA重建技術………………………………………………………… 33
3.5 影像評估…………………………………………………………… 37
第四章 結果…………………………………………………………… 38
4.1 動脈瘤的檢出…………………………………………………………… 38
4.2 3DRA對顱內動脈瘤形態的顯示……………………………………… 42
4.3 3DRA對顱內動脈瘤顯示的特異度…………………………………… 42
第五章 討論……………………………………………………………43
5.1 3DRA的原理及功能……………………………………………………44
5.2 3DRA在檢測顱內動脈瘤的應用價值…………………………………46
5.3 3DRA在顱內動脈瘤治療前後的應用價值……………………………… 47
第六章 結論與未來展望…………………………………………………50
6.1 結論………………………………………………………………………50
6.2 未來展望…………………………………………………………………51
參考文獻…………………………………………………………………………52
1.行政院衛生署 http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=10238&class_no=440&level_no=1
2.Dvaid S. Liebedsinal 著.鄭鲁等譯.腦動脈瘤[J]. 國外醫學腦血管疾病分冊, 2003, 11(2):15l-159.
3.Hop JW, Rinkel GEJ, Algr A, et al. Case fatality rates and functional outcome subarachnoid hemohrrage:a systematic review[J]. Stroke, 1997, 28(3):660-664.
4.Philip M. White, FRCR, Joanna M. Wardlaw, Valerie Easton . Can Noninvasive Imaging Accurately Depict Intracranial Aneurysms? A Systematic Review. Radiology 2000; 217:361–370
5.Mika Okahara, Hiro Kiyosue, Masanori Yamashita, Hirohumi Nagatomi, Hiroyuki Hata, Toshiyuki Saginoya, Yoshiko Sagara, Hiromu Mori. Diagnostic Accuracy of Magnetic Resonance Angiography for Cerebral Aneurysms in Correlation With 3D-Digital Subtraction Angiographic Images: A Study of 133 Aneurysms. Stroke 2002;33;1803-1808
6.Philip M. White, Evelyn M. Teasdale, Joanna M. Wardlaw, Valerie Easton. Intracranial Aneurysms: CT Angiography and MR Angiography for Detection– Prospective Blinded Comparison in a Large Patient Cohort. Radiology 2001; 219:739–749
7.Philip M. White, E Teadsale, J M Wardlaw, V Easton. What is the most sensitive non-invasive imaging strategy for the diagnosis of intracranial aneurysms? Neurol Neurosurg Psychiatry 2001;71:322–328
8.Mehmet Teksam, Alexander McKinney, Sean Casey, Martin Asis, Stephen Kieffer, and Charles L. Truwit. Multi-Section CT Angiography for Detection of Cerebral Aneurysms. AJNR 2004; 25:1485–1492
9.Bernd F. Tomandl, Niels C. Kostner , Miriam Schempershofe Walter J. Huk, Christian Strauss, Lars Anker, Peter Hastreiter. CT Angiography of Intracranial Aneurysms: A Focus on Postprocessing. RadioGraphics 2004; 24:637–655
10.D.Y. Yoon, K.J. Lim, C.S. Choi, B.M. Cho, S.M. Oh, S.K. Chang. Detection and Characterization of Intracranial Aneurysms with 16-Channel Multidetector Row CT Angiography: A Prospective Comparison of Volume-Rendered Images and Digital Subtraction Angiography. AJNR 2007; 28:60–67
11.A.M. McKinney, C.S. Palmer, C.L. Truwit, A. Karagulle, M. Teksam. Detection of Aneurysms by 64-Section Multidetector CT Angiography in Patients Acutely Suspected of Having an Intracranial Aneurysm and Comparison with Digital Subtraction and 3D Rotational Angiography. AJNR 2008; 29:594–602
12.J. Moret, R. Kemkers, J. Op de Beek, R. Koppe, E. Klotz and M. Grass. 3D rotational angiography:Clinical value in endovascular treatment. medicamundi November 1998Volume 42 Issue 3
13.Beth A. Schueler, David F. Kallmes, and Harry J. Cloft. 3D Cerebral Angiography: Radiation Dose Comparison with Digital Subtraction Angiography. AJNR 2005; 26:1898–1901
14.W.J. van Rooij, M.E. Sprengers, A.N. de Gast, J.P.P. Peluso, M. Sluzewski. 3D Rotational Angiography: The New Gold Standard in the Detection of Additional Intracranial Aneurysms. AJNR 2008; 29:976 –79
15.W.J. van Rooij, J.P.P. Peluso, M. Sluzewski, G.N. Beute. Additional Value of 3D Rotational Angiography in Angiographically Negative Aneurysmal Subarachnoid Hemorrhage: How Negative Is Negative. AJNR 2008; 29:962– 66
16.中時健康網網站. http://health.chinatimes.com/blog/neckcare/index_at1006.html
17.中時健康網網站. http://health.chinatimes.com/blog/neckcare/index_at900.html
18.腦血管疾病與介入性治療網. http://www.intervention.com.tw/embolism.asp?id=45&sid=67
19.俞勝正、劉宏智,利用CT血管攝影影像所建立的腦血管顯示系統,加馬、第四十期,中華民國九十八年六月。
20.莊克士編著,醫學影像物理學,合記圖書出版社,八十七年十月十日初版一刷
21.鄭慶明編譯,Armstrong 醫學影像診斷學,合記圖書出版社,2006年2月10日初版五刷
22.游祥明、宋晏仁、古宏海、傅毓秀、林光華編著,解剖學,匯華圖書出版股份有限公司,2002年2月一版三刷
23.http://www.wikidoc.org/index.php/Circle_of_Willis
24.http://www.jeffersonhospital.org/Tests-and-Treatments/endovascular-coiling.aspx
25.http://knol.google.com/k/subarachnoid-hemorrhage-sah
26.http://www.pauldurso.com/treatRadAneurysm.htm
27.http://www.neurosurgery-blog.com/archives/1981
28.Cornelis G, Bellet A, van Eygen B, Roisin P, Libon E. Rotation Multiple Sequence Roentgenography of Intracranial Aneurysm. Acta Radiol Diagn (Stockh), 1972; 13:74-76
29.Voigt K, Stoeter P, Petersen D. Rotational Cerebral Roentgenography I. Evaluation of the Technical Procedure and Diagnostic Application with Model studies. Neuroradiology, 1975; 10:95-100
30.Thron A, Voigt K. Rotational cerebral angiography: Procedure and value. AJNR Am Neuroradiol, 1983; 4:289-291
31.Hoff DJ, Wallace MC, terBrugge KG, Gentili F. Rotational Angiography Assessment of Intracranial Aneurysms. AJNR Am Neuroradiol, 1994; 15:1945-1948
32.Schumacher M, Kutluk K, Ou D. Digital Rotational Radiography in Neuroradiology. AJNR Am Neuroradiol, 1989; 10:644-649
33.Ishihara S, Ross IB, Piotin M. 3D Rotational Angiography: Recent Experience in the Evaluation of Cerebral Aneurysms for Treatment. Intervent Neuroradiol, 2000; 6:85-94
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