头颈部3D-CTA与DSA影像融合技术在神经介入手术中的初步应用
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摘要
目的探讨头颈部三维计算机断层摄影血管造影术(3D-CTA)与数字减影血管造影(DSA)影像融合技术在神经介入手术中的初步应用。方法选取2014年12月~2016年6月之间我院收住的经头颈CTA检查诊断为脑血管疾病(动脉瘤或动脉狭窄)患者30例。其中17例患者行全脑血管造影检查,病变血管进行3D-DSA检查,并将患者3D-CTA图像融合于血管造影机中,分别将2D-DSA和3D-DSA图像进行融合对比,验证CTA与DSA图像位置准确度、血管直径、病变大小的差别。另13例拟进行介入治疗患者,将头颈3D-CTA融合于血管机,利用3D-CTA实时引导并完成介入治疗操作,评价融合的准确度,比较射线照射剂量及造影剂使用量。结果17例患者头颈CTA图像与2D、3D-DSA图像的匹配准确。13例介入患者头颈CTA图像可以成功的应用于神经介入操作过程中3D路图的实时引导,准确完成介入手术;两组患者造影剂使用量分别为(68.5±6.9)ml和(109.5±12.4)ml,接受射线照射剂量分别为(910.1±95.8)mGy和(1769.0±303.2)mGy,具有统计学意义(P<0.05)。结论 3D-CTA影像融合技术因其高度的准确性,可以应用于脑血管病的诊治。影像融合技术可以引导神经介入操作,增加工作效率,同时又能显著降低射线辐射量和造影剂使用量,因此可以降低潜在的医疗风险、提高治疗的安全性。
Objective This study aimed to investigate the head and neck 3 D-CTA and DSA image fusion technology used in neuro interventional procedures.Methods From December2014 to June 2016,the head and neck CTA examination was performed for 30 patients diagnosed with cerebral vascular disease(aneurysm or stenosis).17 patients received the diagnostic cerebral angiography.3 D-DSA was acquired additionally to examine vascular lesions.Pre-op 3 D-CTA was then registered with 3 D-DSA and the fusion accuracy was verified by comparing it with2 DDSA and 3 D-DSA in terms of location accuracy,vascular diameter,lesion size difference.The other 13 patients were planned for interventional treatment conducted with registered head and neck3 D-CTA as real-time guidance.The fusion and guidance accuracy,radiation dose to patients and the contrast agent usage were evaluated.Results Good accuracy in the 3 Dregistration was achieved for the 17 patients,confirmed by high degree matching between 3 D-CTA with 2 D-and 3 D-DSA.In the other 13 patient,it has been shown that 3 D-CTA could be used to provide accurate 3 Droadmaps and thus successfully guide the interventional treatment procedures.The use of contrast agents in the two groups was(68.5±6.9)ml and(109.5±12.4)ml,and the dose of radiation exposure was(910.1±95.8)mGy and(1769±303.2)mGy,with statistical significance(P<0.05).Conclusion Accurate 3 D-CTA and DSA fusion technology was confirmed.Therefore,this technology can be used in the diagnosis and treatment of neuro vascular diseases.Image fusion technology can guide the interventional procedures,increase clinical workflow efficiency,significantly reduce radiation dose and contrast agent usage,thus reduce the potential medical risks,and improve the safety of the treatment.
Objective This study aimed to investigate the head and neck 3 D-CTA and DSA image fusion technology used in neuro interventional procedures.Methods From December2014 to June 2016,the head and neck CTA examination was performed for 30 patients diagnosed with cerebral vascular disease(aneurysm or stenosis).17 patients received the diagnostic cerebral angiography.3 D-DSA was acquired additionally to examine vascular lesions.Pre-op 3 D-CTA was then registered with 3 D-DSA and the fusion accuracy was verified by comparing it with2 DDSA and 3 D-DSA in terms of location accuracy,vascular diameter,lesion size difference.The other 13 patients were planned for interventional treatment conducted with registered head and neck3 D-CTA as real-time guidance.The fusion and guidance accuracy,radiation dose to patients and the contrast agent usage were evaluated.Results Good accuracy in the 3 Dregistration was achieved for the 17 patients,confirmed by high degree matching between 3 D-CTA with 2 D-and 3 D-DSA.In the other 13 patient,it has been shown that 3 D-CTA could be used to provide accurate 3 Droadmaps and thus successfully guide the interventional treatment procedures.The use of contrast agents in the two groups was(68.5±6.9)ml and(109.5±12.4)ml,and the dose of radiation exposure was(910.1±95.8)mGy and(1769±303.2)mGy,with statistical significance(P<0.05).Conclusion Accurate 3 D-CTA and DSA fusion technology was confirmed.Therefore,this technology can be used in the diagnosis and treatment of neuro vascular diseases.Image fusion technology can guide the interventional procedures,increase clinical workflow efficiency,significantly reduce radiation dose and contrast agent usage,thus reduce the potential medical risks,and improve the safety of the treatment.
引文
[1]Sheng LQ,Li J,Li HH,et al.Evaluation of cerebral arteriovenous malformation using'dual vessel fusion'technology[J].J Neurointervent Surg,2014,6(9):667~671.
[2]Sugimoto T,Park YS,Nakagawa I,et al.Effectiveness of intraoperative indocyanine green videoangiography in direct surgical treatment of pediatric intracranial pial arteriovenous fistula[J].J Neurosurg Pediatr,2015,15(1):55~59.
[3]张翔圣,张鑫,张庆荣,等.MRI与3D-DSA融合技术在脑动静脉畸形手术的应用研究[J].中华神经外科疾病研究杂志,2016,15(4):334~337.
[4]Paramasivam S,Toma N,Niimi Y,et al.Development,clinical presentation and endovascular management of congenital intracranial pial arteriovenous fistulas[J].J Neurointervent Surg,2013,5(2):184~190.
[5]Luo CB,Guo WY,Teng MM,et al.Fistula components of brain arteriovenous malformations:angioarchitecture analysis and embolization prior to gamma-knife surgery[J].J Chin Med Assoc,2013,76(5):277~281.
[6]韦可,姚国杰,龚杰,等.MRI与Dyna-CTA/3DDSA影像融合在鞍旁跨颅中后窝肿瘤手术中的应用价值[J].中国临床神经外科杂志,2015,20(7):385~388.
[7]Abecassis IJ,Xu DS,Batjer HH,et al.Natural history of brain arteriovenous malformations:a systematic review[J].Neurosurg Focus,2014,37(3):7.
[8]Paramasivam S,Toma N,Niimi Y,et al.Development,clinical presentation and endovascular management of congenital intracranial pial arteriovenous fistulas[J].J Neurointervent Surg,2013,5(2):184~190.
[9]刘宇清,吕翱,黄绳跃,等.基于颅脑CTA 3D打印技术在颅内动脉瘤手术治疗中的应用[J].中国微侵袭神经外科杂志,2016,21(6):245~247.
[10]Chen W,Choi EJ,McDougall CM,et al.Brain arteriovenous malformation modeling,pathogenesis,and novel therapeutic targets[J].Transl Stroke Res,2014,5(3):316~329.
[11]Ming Yang,Jie Wu,Lianting Ma,et al.The value of syngo dyna PBV neuro during neuro-Interventional hypotensive balloon occlusion test[J].Clin Neuroradiol,201425(5):1~9.
[12]Crowley RW,Ducruet AF,McDougall CG,et al.Endovascular advances for brain arteriovenous malformations[J].Neurosurgery,2014,74(1):74~82.
[13]盛柳青,李俊,陈刚,等.MRI与DSA三维影像数据输入神经导航融合行脑深部血管病直视手术的探讨[J].中国临床神经外科杂志,2015,20(4):193~197.
[14]Chappell ET,Moure FC,Good MC.Comparision of computed tomographic angiograpgy with digital subtraction angiography in the diagnosis of cerebral aneurysms:a meta analysis[J].Neurosuery,2013,52(3):624~631.
[15]Serafin Z,Strze'sniewski P,Lasek W,et al.Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA[J].Neuroradiology,2012,54(2):1381.
[16]魏志华,栾建华,陈光忠.3D-DSA MIP在颅内动脉瘤术后随访中应用初探[J].临床放射学杂志,2014,33(6):944~946.
[2]Sugimoto T,Park YS,Nakagawa I,et al.Effectiveness of intraoperative indocyanine green videoangiography in direct surgical treatment of pediatric intracranial pial arteriovenous fistula[J].J Neurosurg Pediatr,2015,15(1):55~59.
[3]张翔圣,张鑫,张庆荣,等.MRI与3D-DSA融合技术在脑动静脉畸形手术的应用研究[J].中华神经外科疾病研究杂志,2016,15(4):334~337.
[4]Paramasivam S,Toma N,Niimi Y,et al.Development,clinical presentation and endovascular management of congenital intracranial pial arteriovenous fistulas[J].J Neurointervent Surg,2013,5(2):184~190.
[5]Luo CB,Guo WY,Teng MM,et al.Fistula components of brain arteriovenous malformations:angioarchitecture analysis and embolization prior to gamma-knife surgery[J].J Chin Med Assoc,2013,76(5):277~281.
[6]韦可,姚国杰,龚杰,等.MRI与Dyna-CTA/3DDSA影像融合在鞍旁跨颅中后窝肿瘤手术中的应用价值[J].中国临床神经外科杂志,2015,20(7):385~388.
[7]Abecassis IJ,Xu DS,Batjer HH,et al.Natural history of brain arteriovenous malformations:a systematic review[J].Neurosurg Focus,2014,37(3):7.
[8]Paramasivam S,Toma N,Niimi Y,et al.Development,clinical presentation and endovascular management of congenital intracranial pial arteriovenous fistulas[J].J Neurointervent Surg,2013,5(2):184~190.
[9]刘宇清,吕翱,黄绳跃,等.基于颅脑CTA 3D打印技术在颅内动脉瘤手术治疗中的应用[J].中国微侵袭神经外科杂志,2016,21(6):245~247.
[10]Chen W,Choi EJ,McDougall CM,et al.Brain arteriovenous malformation modeling,pathogenesis,and novel therapeutic targets[J].Transl Stroke Res,2014,5(3):316~329.
[11]Ming Yang,Jie Wu,Lianting Ma,et al.The value of syngo dyna PBV neuro during neuro-Interventional hypotensive balloon occlusion test[J].Clin Neuroradiol,201425(5):1~9.
[12]Crowley RW,Ducruet AF,McDougall CG,et al.Endovascular advances for brain arteriovenous malformations[J].Neurosurgery,2014,74(1):74~82.
[13]盛柳青,李俊,陈刚,等.MRI与DSA三维影像数据输入神经导航融合行脑深部血管病直视手术的探讨[J].中国临床神经外科杂志,2015,20(4):193~197.
[14]Chappell ET,Moure FC,Good MC.Comparision of computed tomographic angiograpgy with digital subtraction angiography in the diagnosis of cerebral aneurysms:a meta analysis[J].Neurosuery,2013,52(3):624~631.
[15]Serafin Z,Strze'sniewski P,Lasek W,et al.Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA[J].Neuroradiology,2012,54(2):1381.
[16]魏志华,栾建华,陈光忠.3D-DSA MIP在颅内动脉瘤术后随访中应用初探[J].临床放射学杂志,2014,33(6):944~946.