DSA和MRA随访测量颅内动脉瘤栓塞残余的大小
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摘要
目的比较三维数字减影血管造影(3D-DSA)和磁共振血管造影(MRA),随访测量颅内动脉瘤栓塞残余的大小。方法手术3个月后随访,72例患者中26例动脉瘤未完全闭塞。残余血管瘤的直径和体积分别采用3D-DSA、时间飞跃MRA(time-of-flight MRA,TOF-MRA)、造影剂增强TOF-MRA (CE-TOF MRA)、造影剂增强MRA方法测量,并进行对比。结果根据3D-DSA和所有MRA模式计算的残余体积之间有显著关联。观察者内部变异为3.4%～4.1%,观察者间变异为5.8%～7.3%。测量技术之间的变异差异无统计学意义。平均残余填充体积范围由TOF-MRA的(16.3±19.0) mm~3至3D-DSA的(30.5±44.)6 mm~(3 )(P<0.04)。3D-DSA和CE-MRA测量的体积与TOF-MRA及d CE-TOF-MRA (P<0.01)比较差异有统计学意义。结论 TOF-MRA似乎低估随访时发现动脉瘤残留大小,不应作为唯一的成像方法来决定是否需要再栓塞。
Objective The purpose of this study was to compare 3 D digital subtraction angiography(3 D-DSA) with magnetic resonance angiography(MRA) to measure the residual size of intracranial aneurysms.Methods Patients with intracranial aneurysms followed up for 3 months after operation,the aneurysm was not completely occluded in 26 of 72 patients.The diameter and volume of residual hemangioma were measured by 3 D-DSA,time MRA(time-of-flight MRA,TOF-MRA),contrast enhanced TOF-MRA(CE-TOF MRA),contrast enhanced MRA method,and compared.Results There is a significant correlation between the residual volume calculated according to 3 D-DSA and all MRA models.The intra-observer variation was 3.4%-4.1% and the inter-observer variation was 5.8%-7.3%.There was no significant difference in variation between measurement techniques.The average residual filling volume ranges from 16.3±19.0 mm~3 in TOF-MRA to 30.5±44.6 mm~3 in 3 D-DSA(P<0.04).3 D-DSA and CE-MRA were significantly different from TOF-MRA and d CE-TOF-MRA(P<0.01).Conclusion TOF-MRA seems to underestimate the residual size of aneurysms at follow-up and should not be used as the only imaging method to determine the need for re-embolization.
Objective The purpose of this study was to compare 3 D digital subtraction angiography(3 D-DSA) with magnetic resonance angiography(MRA) to measure the residual size of intracranial aneurysms.Methods Patients with intracranial aneurysms followed up for 3 months after operation,the aneurysm was not completely occluded in 26 of 72 patients.The diameter and volume of residual hemangioma were measured by 3 D-DSA,time MRA(time-of-flight MRA,TOF-MRA),contrast enhanced TOF-MRA(CE-TOF MRA),contrast enhanced MRA method,and compared.Results There is a significant correlation between the residual volume calculated according to 3 D-DSA and all MRA models.The intra-observer variation was 3.4%-4.1% and the inter-observer variation was 5.8%-7.3%.There was no significant difference in variation between measurement techniques.The average residual filling volume ranges from 16.3±19.0 mm~3 in TOF-MRA to 30.5±44.6 mm~3 in 3 D-DSA(P<0.04).3 D-DSA and CE-MRA were significantly different from TOF-MRA and d CE-TOF-MRA(P<0.01).Conclusion TOF-MRA seems to underestimate the residual size of aneurysms at follow-up and should not be used as the only imaging method to determine the need for re-embolization.
引文
[1] BROTT T,ADAMS H P J R,OLINGER C P,et al.Measurements of acute cerebral infarction:a clinical examination scale[J].Stroke,1989,20(7):864-870.
[2] 刘奉立,丛振杰,于本霞,等.结扎兔颈静脉对脑血流灌注的影响[J].医学影像学杂志,2009,19(11):1 477-1 481.
[3] ROLLINS N,ISON C,REYES T,et al.Cerebral MR venography in children:comparison of 2D time-of-flight and gadolinium-enhanced 3D gradient-echo techniques[J].Radiology,2005,235(3):1 011-1 017.
[4] LIANG L,KOROGI Y,SUGAHARA T,et al.Evaluation of the intracranial dural sinuses with a 3D contrast-enhanced MP-RAGE sequence:prospective comparison with 2D-TOF MR venography and digital subtraction angiography[J].AJNR Am J Neuroradiol,2001,22(3):481-492.
[5] HU H H,CAMPEAU N G,HUSTON J,et al.High-spatial-resolution contrast-enhanced MR angiography of the intracranial venous system with fourfold accelerated two-dimensional sensitivity encoding[J].Radiology,2007,243(3):853-861.
[6] SCHREIBER S J,LURTZING F,GOTZE R,et al.Extrajugular pathways of human cerebral venous blood drainage assessed by duplex ultrasound[J].J Appl Physiol,2003,94(5):1 802-1 805.
[7] WINFRIED A,WILLINEK T,MARKUS B ,et al.Time-of-Flight MR Angiography Comparison of 3.0-T Imaging and 1.5-T Imaging-Initial Experience[J].Radiology,2003,229(10):913-920
[8] 徐明昌,黄丽娜,戚纪胜.MRA诊断大脑中动脉M1段狭窄和DSA的对比研究[J].中国实用神经疾病杂志,2013,16(5):38-40.
[9] 冯飞,赵武贻,李中华,等.快速与标准三维时间飞跃法MRA在颅内动脉成像的对比研究[J].磁共振成像,2015,6(6):422-425.
[10] 孙静,张士德,魏永兵,等.3.0T 3D时间飞跃法磁共振颅内血管成像用于介入术前评价的可靠性研究[J].中国临床医学影像杂志,2013,24(3):153-158.
[11] 苏显球,余光权,谢华山,等.脑动脉CTA与MRA对颅内动脉瘤的诊断价值[J].海南医学,2018,29(6):806-808.
[12] RENOWDEN S A,BENES V,BRADLEY M,et al.Detachable coil embolisation of ruptured intracranial aneurysms:a single center study,a decade experience[J].Clin Neurol Neurosurg,2009,111(2):179-88.
[13] GORY B,KLISCH J,BONAFE A,et al.Solitaire AB stent-assisted coiling of wide-necked intracranial aneurysms:short-term results from a prospective,consecutive,European multicentric study[J].Neuroradiology,2013,55(11):1 373-1 378.
[14] 孙晓辉,罗唯师,王墨,等.3D-CTA与3D-DSA在破裂脑动脉瘤介入治疗中的对比研究[J].中国实用神经疾病杂志,2014,17(3):3-5.
[15] 向伟楚,杨铭,李俊,等.DSA与MRI或MRA双三维影像融合技术要点及在颅内动脉瘤诊治中的应用[J].中国临床神经外科杂志,2015,20(2):65-70.
[16] 李乾,任彤,黄巍,等.3D-DSA与MRI影像融合技术及其在脑动静脉畸形术前评估中的应用[J].中国微侵袭神经外科杂志,2016,21(6):241-244.
[17] 张翔圣,张鑫,张庆荣,等.三维DSA与MRI或CT融合技术在颅内动静脉畸形治疗中的应用价值[J].中国脑血管病杂志,2015,12(9):449-455.
[18] 吴忠魁.DSA、CT与MRI融合影像对颅内多发假性动脉瘤的诊治价值[J].中国医药指南,2018,16(31):44.
[19] 马廉亭,杨铭,李俊,等.DSA与Dyna-CT、MRI影像融合新技术在脑脊髓血管病中的应用[J].中华脑血管病杂志(电子版),2014,8(2):30-37.
[20] 孙荣辉,徐国政,杜浩等.MRI与DSA影像融合联合电生理监测对脑动静脉畸形伴癫痫手术的价值[J].中国临床神经外科杂志,2015,20(7):403-406,409.
[21] 成思,张强,毛更生.影像融合技术在脑血管疾病诊治中应用的研究进展[J].河北医科大学学报,2017,38(9):1 112-1 116.
[22] 王在贵,张新元,杨铭,等.MRI、320-CTA及DSA在脊髓血管病诊断中的应用[J].中国临床神经外科杂志,2015,20(11):643-646.
[23] 王庆军,王勇,蔡剑鸣,等.斜矢状位高分辨三维黑血磁共振成像在粥样硬化颈动脉支架术前评估的应用价值[J].中国医学影像学杂志,2011,19(5):367-372.
[24] 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.
[25] 刘青.早期介入栓塞在脑动脉瘤破裂中的治疗效果及预后[J].中国实用神经疾病杂志,2014,17(17):86.
[26] 胡友珠,邹国荣,黄波,等.显微镜下脑动脉瘤血管夹闭手术80例临床分析[J].长江大学学报(自科版),2014,11(18):16-17,74.
[27] 董全永.显微手术夹闭与血管栓塞术治疗脑动脉瘤的疗效探讨[J].中外医疗,2013,32(23):89-90.
[28] 王伟,王春生,郝华超.脑动脉瘤术后症状性血管痉挛发生的影响因素及预防研究[J].实用预防医学,2012,19(1):94-95.
[29] 郝铭,马小红,鲍向阳,等.尼莫地平预防脑动脉瘤术后脑血管痉挛的效果观察[J].西南国防医药,2017,27(11):1 204-1 206.
[30] 张茂,陈建龙.早期介入栓塞治疗脑动脉瘤破裂的疗效及安全性评价[J].临床和实验医学杂志,2016,15(21):2 135-2 137.
[2] 刘奉立,丛振杰,于本霞,等.结扎兔颈静脉对脑血流灌注的影响[J].医学影像学杂志,2009,19(11):1 477-1 481.
[3] ROLLINS N,ISON C,REYES T,et al.Cerebral MR venography in children:comparison of 2D time-of-flight and gadolinium-enhanced 3D gradient-echo techniques[J].Radiology,2005,235(3):1 011-1 017.
[4] LIANG L,KOROGI Y,SUGAHARA T,et al.Evaluation of the intracranial dural sinuses with a 3D contrast-enhanced MP-RAGE sequence:prospective comparison with 2D-TOF MR venography and digital subtraction angiography[J].AJNR Am J Neuroradiol,2001,22(3):481-492.
[5] HU H H,CAMPEAU N G,HUSTON J,et al.High-spatial-resolution contrast-enhanced MR angiography of the intracranial venous system with fourfold accelerated two-dimensional sensitivity encoding[J].Radiology,2007,243(3):853-861.
[6] SCHREIBER S J,LURTZING F,GOTZE R,et al.Extrajugular pathways of human cerebral venous blood drainage assessed by duplex ultrasound[J].J Appl Physiol,2003,94(5):1 802-1 805.
[7] WINFRIED A,WILLINEK T,MARKUS B ,et al.Time-of-Flight MR Angiography Comparison of 3.0-T Imaging and 1.5-T Imaging-Initial Experience[J].Radiology,2003,229(10):913-920
[8] 徐明昌,黄丽娜,戚纪胜.MRA诊断大脑中动脉M1段狭窄和DSA的对比研究[J].中国实用神经疾病杂志,2013,16(5):38-40.
[9] 冯飞,赵武贻,李中华,等.快速与标准三维时间飞跃法MRA在颅内动脉成像的对比研究[J].磁共振成像,2015,6(6):422-425.
[10] 孙静,张士德,魏永兵,等.3.0T 3D时间飞跃法磁共振颅内血管成像用于介入术前评价的可靠性研究[J].中国临床医学影像杂志,2013,24(3):153-158.
[11] 苏显球,余光权,谢华山,等.脑动脉CTA与MRA对颅内动脉瘤的诊断价值[J].海南医学,2018,29(6):806-808.
[12] RENOWDEN S A,BENES V,BRADLEY M,et al.Detachable coil embolisation of ruptured intracranial aneurysms:a single center study,a decade experience[J].Clin Neurol Neurosurg,2009,111(2):179-88.
[13] GORY B,KLISCH J,BONAFE A,et al.Solitaire AB stent-assisted coiling of wide-necked intracranial aneurysms:short-term results from a prospective,consecutive,European multicentric study[J].Neuroradiology,2013,55(11):1 373-1 378.
[14] 孙晓辉,罗唯师,王墨,等.3D-CTA与3D-DSA在破裂脑动脉瘤介入治疗中的对比研究[J].中国实用神经疾病杂志,2014,17(3):3-5.
[15] 向伟楚,杨铭,李俊,等.DSA与MRI或MRA双三维影像融合技术要点及在颅内动脉瘤诊治中的应用[J].中国临床神经外科杂志,2015,20(2):65-70.
[16] 李乾,任彤,黄巍,等.3D-DSA与MRI影像融合技术及其在脑动静脉畸形术前评估中的应用[J].中国微侵袭神经外科杂志,2016,21(6):241-244.
[17] 张翔圣,张鑫,张庆荣,等.三维DSA与MRI或CT融合技术在颅内动静脉畸形治疗中的应用价值[J].中国脑血管病杂志,2015,12(9):449-455.
[18] 吴忠魁.DSA、CT与MRI融合影像对颅内多发假性动脉瘤的诊治价值[J].中国医药指南,2018,16(31):44.
[19] 马廉亭,杨铭,李俊,等.DSA与Dyna-CT、MRI影像融合新技术在脑脊髓血管病中的应用[J].中华脑血管病杂志(电子版),2014,8(2):30-37.
[20] 孙荣辉,徐国政,杜浩等.MRI与DSA影像融合联合电生理监测对脑动静脉畸形伴癫痫手术的价值[J].中国临床神经外科杂志,2015,20(7):403-406,409.
[21] 成思,张强,毛更生.影像融合技术在脑血管疾病诊治中应用的研究进展[J].河北医科大学学报,2017,38(9):1 112-1 116.
[22] 王在贵,张新元,杨铭,等.MRI、320-CTA及DSA在脊髓血管病诊断中的应用[J].中国临床神经外科杂志,2015,20(11):643-646.
[23] 王庆军,王勇,蔡剑鸣,等.斜矢状位高分辨三维黑血磁共振成像在粥样硬化颈动脉支架术前评估的应用价值[J].中国医学影像学杂志,2011,19(5):367-372.
[24] 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.
[25] 刘青.早期介入栓塞在脑动脉瘤破裂中的治疗效果及预后[J].中国实用神经疾病杂志,2014,17(17):86.
[26] 胡友珠,邹国荣,黄波,等.显微镜下脑动脉瘤血管夹闭手术80例临床分析[J].长江大学学报(自科版),2014,11(18):16-17,74.
[27] 董全永.显微手术夹闭与血管栓塞术治疗脑动脉瘤的疗效探讨[J].中外医疗,2013,32(23):89-90.
[28] 王伟,王春生,郝华超.脑动脉瘤术后症状性血管痉挛发生的影响因素及预防研究[J].实用预防医学,2012,19(1):94-95.
[29] 郝铭,马小红,鲍向阳,等.尼莫地平预防脑动脉瘤术后脑血管痉挛的效果观察[J].西南国防医药,2017,27(11):1 204-1 206.
[30] 张茂,陈建龙.早期介入栓塞治疗脑动脉瘤破裂的疗效及安全性评价[J].临床和实验医学杂志,2016,15(21):2 135-2 137.