旋转DSA三维重建成像与常规DSA在颈动脉狭窄诊治中的比较研究

Comparative study of three-dimensional reconstructed images after rotational DSA and conventional DSA in the diagnosis and treatment of carotid stenosis

目的 探讨旋转DSA三维重建成像 (3DDSA)在颈动脉狭窄诊断及治疗中的价值 ,并与常规DSA(2DDSA)进行比较。方法 对 2DDSA证实的 4 2例患者 5 0条狭窄颈动脉分别进行旋转血管造影和DSA三维成像后处理 ,对其中 19例患者进行内支架成形术及术后 2DDSA和 3DDSA检查。由工作经验丰富的 2位阅片者采用双盲法对 2DDSA和 3DDSA的图像进行分析与测量 ,并计算出血管的直径狭窄率和面积狭窄率。通过仿真血管内镜 (virtualangioscopy ,VA)观察血管内表面斑块的情况。结果 3DDSA与 2DDSA测量颈动脉狭窄的直径狭窄率比较差异无统计学意义 (P >0 0 5 ) ;3DDSA测量的面积狭窄率约 6 8%明显高于 3D及 2DDSA测量的直径狭窄率 P <0 0 1) ,按面积狭窄率对血管狭窄程度进行分级也多数比按直径狭窄率严重 ;3DDSA显示 34条血管存在斑块 ,而 2DDSA仅显示 6条 (P <0 0 0 5 ) ;3D与 2DDSA判断内支架术后狭窄改善情况相比较差异有统计学意义 (P <0 0 5 )。结论 3DDSA判断颈动脉狭窄的准确性优于 2DDSA ,能为颈动脉狭窄的诊断与治疗以及评价疗效提供更丰富的有用信息。

Objective To compare the clinical value of three-dimensional DSA (3D DSA) and conventional DSA (2D DSA) in the diagnosis and treatment of carotid stenosis.Methods Fifty stenosed carotid arteries in 42 patients confirmed by 2D DSA were performed with rotational angiography and three-dimensional reconstruction, of which 19 patients received both 2D DSA and 3D DSA before and after carotid stenting.The images of 3D and 2D DSA were studied double-blindly by two experienced radiologists.Diameters and cross-sectional areas of the most stenotic and distal nonstenotic vessels were calculated.Linear stenosis rate and area stenosis rate were computed with the method of North American Symptomatic Carotid Endarterectomy Trial (NASCET).Atherosclerotic plaques were observed mainly by means of virtual angioscopy (VA). Results There was no statistically significant difference in linear stenosis rate between 3D DSA and 2D DSA(P>0.05).About 68% area stenosis rate of 3D DSA of total cases was significantly greater than the linear stenosis rate of other methods (P<0.01).The grade on area stenosis was higher than that on other methods in most vessels.Only 6 of 34 plaques displayed on 3D DSA were demonstrated on 2D DSA(P<0.005).There was statistical difference between 3D DSA and 2D DSA in assessing the therapeutic efficacy of carotid stenting (P<0.05).Conclusion 3D DSA is more accurate than 2D DSA in evaluating carotid stenosis.3D DSA can offer more valuable information for the diagnosis and treatment of carotid stenosis and assessment for the therapeutic efficacy of carotid stenting.