医学文献翻译中英对照.docx

1、医学文献翻译中英对照Current usage of three-dimensional puted tomography angiography for the diagnosis and treatment of ruptured cerebral aneurysmsKenichi Amagasaki MD, Nobuyasu Takeuchi MD, Takashi Sato MD, Toshiyuki Kakizawa MD, Tsuneo Shimizu MDKanto Neurosurgical Hospital, Kumagaya, Saitama, JapanSummary O

2、ur previous study suggested that 3D-CT angiography could replace digital subtraction (DS) angiography in most cases of ruptured cerebral aneurysms, especially in the anterior circulation. This study reviewed our further experience. One hundred and fifty patients with ruptured cerebral aneurysms were

3、 treated between November 1998 and March 2002. Only 3D-CT angiography was used for the preoperative work-up study in patients with anterior circulation aneurysms, unless the attending neurosurgeons agreed that DS angiography was required. Both 3D-CT angiography and DS angiography were performed in p

4、atients with posterior circulation aneurysms, except for recent cases that were possibly treated with 3D-CT angiography alone. One hundred sixteen (84%) of 138 patients with ruptured anterior circulation aneurysms underwent surgical treatment, but additional DS angiography was required in 22 cases (

5、16%). Only two recent patients were treated surgically with 3D-CT angiography alone in 12 patients with posterior circulation aneurysms. Most patients with ruptured anterior circulation aneurysms could be treated successfully after 3D-CT angiography alone. However, additional DS angiography is still

6、 necessary in atypical cases. 3D-CT angiography may be limited to plementary use in patients with ruptured posterior circulation aneurysms.a 2003 Elsevier Ltd. All rights reserved.Keywords: 3D-CT angiography, cerebral aneurysm, subarachnoid haemorrhage, surgeryINTRODUCTIONRecently, three-dimensional

7、 puted tomography (3D-CT) angiography has bee one of the major tools for the identification of cerebral aneurysms because it is faster, less invasive, and more convenient than cerebral angiography.17 Patients with ruptured aneurysms could be treated under diagnoses based on only 3D-CT angiography.5;

8、6 3D-CT angiography has some limitations for the preoperative work-up for ruptured cerebral aneurysms, so additional digital subtraction (DS) angiography is still necessary, especially for aneurysms in the posterior circulation.8 Our previous study suggested that 3D-CT angiography could replace DS a

9、ngiography in most patients with ruptured cerebral aneurysms in the anterior circulation.1 This study reviewed our experience of treating ruptured cerebral aneurysms in the anterior and posterior circulations based on 3D-CT angiography in 150 consecutive patients to assess the current usage of 3D-CT

10、 angiography.METHODS AND MATERIALPatient populationWe treated 150 patients, 60 men and 90 women aged from 23 to80 years (mean 57.5 years), with ruptured cerebral aneurysmidentified by 3D-CT angiography between November 1998 andMarch 2002.Managementof casesThe presence of nontraumatic subarachnoid ha

11、emorrhage (SAH)was confirmed by CT or lumbar puncture findings of xanthochromiccerebrospinal fluid. 3D-CT angiography was performedroutinely in all patients. DS angiography was performed in patientswith anterior circulation aneurysms only if additional informationwas considered necessary following a

12、 consensusinterpretation of the initial CT and 3D-CT angiography by fourneurosurgeons. Patients with ruptured aneurysms in the posteriorcirculation underwent both 3D-CT angiography and DS angiographyexcept for two recent patients with typical vertebral arteryposteriorinferior cerebellar artery (VA-P

13、ICA) aneurysm.Typical saccular aneurysms were treated by clipping surgery.Fusiform and dissecting aneurysms were treated by proximal occlusionby either surgery or endovascular treatment with orwithout bypass surgery. Regrowth of bleeding aneurysms wastreated by either surgery or endovascular treatme

14、nt. Postoperatively,all patients were managed with aggressive prevention andtreatment of vasospasm including intra-arterial infusion of papaverineor transluminal angioplasty.3D-CT angiography acquisition and postprocessingCT angiography was performed with a spiral CT scanner (CT-W3000 AD; Hitachi, I

15、baraki, Japan). Acquisition used a standardtechnique starting at the foramen magnum, with injection of130 ml of nonionic contrast material (Omnipaque; Daiichi Pharmaceutical,Tokyo, Japan). The source images of each scan weretransferred to an off-line puter workstation (VIP station;Teijin System Tech

16、nology, Japan). Both volume-rendered imagesand maximum intensity projection images of the cerebral arterieswere constructed. The anterior circulation and posterior circulationwere evaluated separately on the volume-rendered images,after a general superior view was obtained. The anterior circulationw

17、as evaluated by first observing the anterior municatingartery (ACoA) by rotating the view, and then each side of thecarotid system by rotating the image with editing out of thecontralateral carotid artery. The posterior circulation was alsoevaluated by rotating the image but without editing out of a

18、nyvessel. Once a possible rupture site was found, the view waszoomed and closely rotated with the other vessels edited out. Theaneurysm size was measured on 3D-CT angiography as the largerof the length of the dome or the width of the neck. Manipulationwas performed by the scanner technician, with a

19、neurosurgeon toprovide editing assistance.DS angiography acquisitionStandard selective three- or four-vessel DS angiograms withfrontal, lateral, and oblique projections were obtained. The 3D-CTangiogram was always available as a guide for possible additionalDS angiography projections. Aneurysm size

20、was measured withDS angiography when the quality of 3D-CT angiography wasinadequate. All patients except elderly patients or patients in severecondition underwent DS angiography postoperatively.Grading of patientsThe clinical conditions of the patients at admission were classifiedaccording to the Hu

21、nt and Kosnik grade.9 Clinical oute wasdetermined at 3 months according to the Glasgow OuteScale.10RESULTSThe aneurysm locations and sizes are shown in Table 1. Onehundred sixteen (84%) of 138 cases of aneurysms in the anteriorcirculation were treated after only 3D-CT angiography, and 22cases (16%)

22、required additional DS angiography. Ten of 12 casesof aneurysms in the posterior circulation required both 3D-CTangiography and DS angiography, but two recent cases of typicalVA-PICA aneurysm were clipped after only 3D-CT angiography(Fig. 1). The first 10 of the 22 cases in the anterior circulation,

23、which required additional DS angiography were described previously,1 so the most recent 12 patients are listed in Table 2.These recent cases included some atypical aneurysms. Cases 6and 8 had a fusiform aneurysm of the internal carotid artery (ICA).Additional DS angiography was performed to obtain h

24、aemodynamicinformation. ICA trapping with superficial temporal artery-middle cerebral artery anastomosis was performed in Case 6because the atherosclerotic arteries failed to demonstrate theballoon occlusion test (Fig. 2). ICA occlusion by endovasculartreatment was performed in Case 8 because the pa

25、tient couldtolerate the balloon occlusion test. Cases 4, 9, and 10 sufferedregrowth of bleeding aneurysms after clipping surgery. Clip artifactsprevented evaluation of the ruptured site as well as identificationof de novo aneurysms in these cases (Fig. 3). Surgicalclipping was performed in Cases 4 a

26、nd 10 and endovasculartreatment in Case 9. Case 11 had an ACoA aneurysm associatedwith an arteriovenous malformation (AVM) (Fig. 4). DS angiographywas performed to evaluate the AVM. Case 12 had a largeICA-posterior municating artery (PCoA) aneurysm, and additionalDS angiography was performed because

27、 the PCoA couldnot be detected by 3D-CT angiography (Fig. 5). Cases 1, 2, 3, 5,and 7 presented with small aneurysms, and DS angiography wasperformed to exclude other lesions as well as to obtain informationabout the proximal ICA for patients with supraclinoid type aneurysms.Table 1 Distribution and

28、size of cerebral aneurysms in 150 consecutivepatientsSite No. of patientsAnterior circulation 138ICA (supraclinoid) 3ICA bifurcation 1ICA-OphA 3ICA-PCoA 39 (1)ICA fusiform 2ACoA 50Distal ACA 4MCA 36 (1)Posterior circulation 12PCA1BA tip 3BA-SCA 1BA trunk 1 (1)VA-PICA 3VA dissecting3 (1)Size (mm)5 42

29、P5 to 12 99P12 9Number in parentheses indicates patients who underwent endovasculartreatment.OphA, ophthalmic artery; ACA, anterior cerebral artery; MCA, middle cerebralartery; PCA, posterior cerebral artery; BA, basilar artery; SCA, superiorcerebellar artery.Table 2 Twelve patients with ruptured an

30、terior circulation aneurysms whounderwent additional DS angiographyCase No. Location Size (mm)1 lt. ICA-PCoA 3.12 ACoA 2.23 lt. ICA supraclinoid 1.64 lt. ICA-PCoA 7.85 lt. ICA supraclinoid 2.46 lt. ICA (fusiform) 11.87 lt. ICA-PCoA 3.28 rt. ICA (fusiform) 18.89 lt. MCA 9.610 lt. ICA-PCoA 10.511ACoA

31、10.112 lt. ICA-PCoA 18.2The surgical findings correlated well with the 3D-CT angiographyor DS angiography. Table 3 shows the condition on admissionand oute at 3 months after surgery. Some patientswith good grades on admission died of severe spasm, acute brainswelling, or poor general condition, but

32、these outes were notrelated to the preoperative radiological information.DISCUSSIONThe present study of ruptured aneurysms in both anterior andposterior circulations found that the indications for additional DSangiography in the anterior circulation are similar to that foundpreviously, but we experienced some new atypical cases. Treatmentof fusiform aneurysms depends on the haemodynamic information,which could only be obtained by DS angiography. ACoA aneurysm associated with AVM, although the initial CTindicated that the aneurysm had bled, required accurate