雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 32, Issue 6 （June 2004）

Neurological Surgery 脳神経外科 32巻6号（2004年6月発行）

Japanese English

研究

MRAで検出されなかった未破裂脳動脈瘤 Unruptured Cerebral Aneurysms; the Features of Cases Undetected with MR Angiography 片野広之 ^1,3 , 唐沢洲夫 ¹ , 杉山尚武 ¹ , 山下伸子 ¹ , 佐々木繁 ² , 神谷健 ¹ , 山田和雄 ³ Hiroyuki KATANO ^1,3 , Kunio KARASAWA ¹ , Naotake SUGIYAMA ¹ , Nobuko YAMASHITA ¹ , Shigeru SASAKI ² , Ken KAMIYA ¹ , Kazuo YAMADA ³ ¹名古屋市立東市民病院脳神経外科 ²名古屋市立東市民病院放射線科 ³名古屋市立大学大学院医学研究科神経機能回復学（脳神経外科） ¹Department of Neurosurgery,Nagoya City Higashi General Hospital ²Department of Radiology,Nagoya City Higashi General Hospital ³Department of Neurosurgery and Restorative Neuroscinece,Nagoya City University Guraduate School of Medical Scinece キーワード： magnetic resonance angiography , digital subtraction angiography , unruptured cerebral aneurysm , brain dock , false-negative Keyword: magnetic resonance angiography , digital subtraction angiography , unruptured cerebral aneurysm , brain dock , false-negative pp.587-594

発行日 2004年6月1日 Published Date 2004/6/1

DOI https://doi.org/10.11477/mf.1436100399

PDF(315KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　Ⅰ．はじめに

MRI，MRAの著しい進歩により，外来における新規患者や他疾患で経過観察中の患者に対するスクリーニングのMRAや脳ドックなどで，脳動脈瘤が未破裂のうちに発見，治療されることが多くなった¹⁰⁾．未破裂動脈瘤に関しては，現在，わが国における自然歴（破裂率）と治療の実態調査から治療方針を探る日本未破裂脳動脈瘤悉皆調査（UCAS Japan）が進行中であり¹⁴⁾，関心も高まっている．しかし，MRAによる脳動脈瘤の検出に関しては，依然としていわゆるfalse-positive，false-negativeの症例が少なくなく，現状では通常これらのスクリーニングMRAで疑われた病変は，3D-CTAや脳血管撮影（DSA）を施行して確認することが多い．今回われわれは，外来スクリーニングのMRAで動脈瘤が疑われた症例を検討し，特にDSAによって新たに確認され，MRAでは検出されなかった動脈瘤の特徴について調べた．

　With the development of MRI and MRA,many unruptured aneurysms have been detected and treated. Nevertheless,not a few false-positive and false-negative cases are found. We investigate aneurysms that were suspected after screening MRA at the neurosurgical outpatient clinic and the features of aneurysms detected not with MRA but with DSA were studied. Seventy-six patients (85 aneurysms) were suspected due to screening MRA and DSA was performed in 64 (71 aneurysms) of them. Correct diagnosis of cerebral aneurysms with MRA was obtained in 44 patients (45 aneurysms,63.4%),while false-negative cases were found in 17 patients (plus 20 aneurysms) and false-positive cases in 7 patients (10 aneurysms). The accuracy was 97.2% in ACA,93% in MCA,94.4% in VA-BA,and 78.9% in IC,while the sensitivity 100%,88.2%,81.8%,64.7% and the specificity 96.5%,94.4%,96.7%,91.9%,respectively. The features of aneurysms correctly diagnosed with MRA were relatively large ACA,including AcoA,MCA and VA-BA aneurysms,whereas the features of aneurysms undetected with MRA were small IC aneurysms (1-3mm in diameter),especially at the C2-3 portion. These aneurysms at the C2-3portion or at unusual portions tended to be difficult to detect even with 3D-CTA. Though most of the aneurysms detected with DSA but not with MRA tended to be small and not interventionally treated in the present study,we should pay attention to the fact that these aneurysms are overlooked despite the possibility that they may become enlarged or rupture. Though ruptured aneurysms were surgically treated with only MRA or 3D-CTA without conventional angiography in these days,we recommend the examination of the unruptured cases,which are usually asymptomatic and not hasty,with precise inspection by target MIP,high-performance 3D-CTA or DSA.