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目的探讨自发性蛛网膜下腔出血(subarachnoid hemorrhage,SAH)首次CT血管造影(computed tomography angiography,CTA)检查阴性的原因及治疗策略。方法对本院2008年1月至2009年11月,首次CTA检查呈阴性的31例SAH患者的诊断、治疗进行回顾性分析。结果本组31例(男性12例,女性19例)中29例再次CTA检查,发现动脉瘤7例,其中3例为小脑后下动脉瘤,2例大脑中动脉M3段动脉瘤,1例大脑前动脉A2段动脉瘤,1例大脑后动脉P3段动脉瘤;3例颅内动脉远端显示不清晰,怀疑动静脉畸形(arteriovenous malformation,AVM)。再次CTA检查的22例阴性患者同期行DSA检查,发现前交通动脉瘤2例,均小于1.5mm;AVM3例;C5-7颈髓AVM1例;硬脑膜动静脉瘘1例。延期MRA检查7例,发现海绵状血管瘤3例。其余14例均无阳性发现,其中1例做了2次CTA,2次DSA,2次MRA检查,仍无阳性发现。结论蛛网膜下腔出血患者首次CTA阴性的原因较多,为提高诊断率及避免不必要重复检查,应根据CT平片上蛛网膜下腔出血特点确定合理的进一步检查手段。
Objective To investigate the causes and treatment strategies of negative primary CT angiography (CTA) in patients with subarachnoid hemorrhage (SAH). Methods A retrospective analysis was performed on the diagnosis and treatment of 31 SAH patients who were negative in the first CTA examination from January 2008 to November 2009 in our hospital. Results Of the 31 patients (12 males and 19 females), CTA examination was performed again in 29 of 29 aneurysms, of which 3 were posterior inferior cerebellar aneurysms, 2 were middle cerebral artery aneurysms, and 1 was cerebral A2 aneurysm in the anterior artery, and P3 aneurysm in the posterior cerebral artery in 3 cases. The distal part of the intracranial artery showed unclear and suspected arteriovenous malformation (AVM) in 3 cases. Again CTA examination of 22 cases of negative patients underwent DSA examination at the same period, found that two cases of anterior communicating aneurysms, were less than 1.5mm; AVM3 cases; C5-7 cervical AVM1 cases; dural arteriovenous fistula in 1 case. Delayed MRA examination in 7 cases, found in 3 cases of cavernous hemangiomas. The remaining 14 cases were found no positive, including 1 case of 2 CTA, 2 DSA, 2 MRA examination, still no positive findings. Conclusions There are many reasons for the first negative CTA in patients with subarachnoid hemorrhage. To improve the diagnostic rate and avoid unnecessary duplication of examinations, reasonable further examination should be based on the characteristics of subarachnoid hemorrhage on CT plain film.