平板DSA-3DRA融合技术及其在颅内动脉瘤栓塞术后的应用

Application of 3DRA Clone Fusion Technique in Embolization of Intracranial Aneurysm

目的探讨DSA-三维旋转血管造影(3DRA)克隆融合技术在颅内动脉瘤栓塞术后复查的应用价值。方法回顾性分析本院2016年1月至2018年12月59例颅内动脉瘤血管内栓塞治疗术患者资料。术前行2D-DSA检查,发现责任动脉瘤后,即行DSA-3DRA旋转采集,通过2D-DSA及3DRA图像确定责任动脉瘤性质、形态、大小及与邻近血管的关系,评估手术风险并确定手术方案,行颅内动脉瘤血管内栓塞治疗术;术后行DSA-3DRA复查,数据传输至Philips Allura X-per DSA Xtravision 3D后处理工作站,应用图像融合三维重组技术进行图像后处理,术前、术后三维图像进行对比,评价动脉瘤栓塞效果。结果选取的59例动脉瘤栓塞治疗术患者共发现动脉瘤66枚(6例颅内多发动脉瘤),其中61枚动脉瘤行血管内栓塞治疗术(25枚动脉瘤行单纯弹簧圈栓塞,36枚动脉瘤支架辅助下弹簧圈栓塞);术后均随访复查病例(其中30例术后即刻复查,5例术后三个月复查,10例术后半年复查,14例术后一年复查);其中次全栓塞即2级栓塞5枚(8%),不全栓塞即3级栓塞4枚(7%),余52枚(85%)动脉瘤达到完全栓塞即1级栓塞。结论3DRA克隆融合技术较常规3D后处理图像具有更佳的对比度,对评估动脉瘤血管内栓塞治疗术后的瘤体或瘤颈的残留情况、弹簧圈的形态、致密程度及其对周围血管的影响都有着重要意义;对术者决定是否进行进一步栓塞治疗有较大帮助,并为术后的随访复查提供重要的信息。

Objective To evaluate the value of DSA-3 DRA clone fusion technique application in the postsurgical examination of intracranial aneurysms embolization.Methods 59 cases of patients with intracranial aneurysms treated by endovascular embolization surgery from January 2016 to December 2018 were reviewed and analyzed.In these cases,2 D-DSA examination was performed and responsible aneurysms were identified before surgery,then DSA-3 DRA rotation operation was done afterwards.The images collected through 2 D-DSA and DSA-3 DRA were used to observe the nature,shape,size of the aneurysms and its relationship with the adjacent vessels,these images also helped to evaluate the operative risks,determine the operative plan and to conduct the surgery.DSA-3 DRA was conducted again after endovascular embolization treatment and the results was transferred to Phillips Allura-X-Per DSA Xtravision 3 D post processing workstation.The images based on 3 D clone image reconstruction technology was used to conduct preoperative and postoperative comparison and evaluate the condition of intracranial aneurysms embolization.Results A total of 66 aneurysms(6 multiple intracranial aneurysms)were found in 61 cases aneurysms embolization.Among them,61 aneurysms were treated by embolization(25 aneurysms were through simple coil embolisation and 36 aneurysms through stent-assisted coil embolization).All cases were followed up after operation(30 cases were immediately reviewed after operation,5 cases were reviewed three months after operation,10 cases were reviewed half a year afte operation,14 cases were reviewed one year after operation).Among them,52 cases(85%)had complete embolisation,i.e.grade 1 embolisation.5 cases(8%)had sub-total embolisation,i.e.grade 2 embolisation,and the remaining 4 cases(7%)had incomplete embolisation,i.e.grade 3 embolisation.Conclusion 3 DRA clone fusion technology offers much greater comparison than that of conventional 3 D post-processing technology.It has significant influence on the evaluation of the residual condition of aneurysm or aneurysm neck,the shape of the coil,density of the coil and its effect on the surrounding blood vessels.This technology is also beneficial for further embolization treatment and follow-up after operation.