旋转DSA三维重建成像评价经皮椎体成形术后PMMA渗漏

Rotational DSA three-dimensional reconstructed images in evaluation of PMMA extravasation after percutaneous vertebroplasty

目的运用旋转数字减影血管造影（DSA）三维重建成像，评价经皮椎体成形术后聚甲基丙烯酸甲酯（PMMA）渗漏。方法2005年9月～2007年9月，35例患者共46个胸椎和腰椎椎体行经皮椎体成形术（PVP）。收集患者的临床和影像学资料，术后经旋转DSA采集及三维重建成像，分析PMMA的椎体外渗漏图像和临床情况，并应用螺旋CT检查进行验证。结果在经PVP术后的46个椎体中，经侧位X线片、旋转DSA三维重建图像和CT检查，36个椎体明确无椎体外渗漏；10个椎体出现椎体外渗漏，其中2个椎体为椎间盘渗漏；2个椎体为椎旁软组织渗漏；5个椎体为静脉丛渗漏；1例为椎弓根渗漏，该例在侧位X线片怀疑为椎体后缘硬膜外渗漏，但经DSA三维重建图像和螺旋CT检查显示，PMMA位于两侧椎弓根内，椎管内并无PMMA。结论旋转DSA三维重建成像能迅速对PVP术后PMMA渗漏进行准确的判断。

Objective To explore the application of rotational digital subtraction angiography （ DSA ） three-dimensional reconstructed images in evaluation of polymethylmethacrylate （PMMA） extravasation after percutaneous vertebroplasty （PVP）. Methods From Sept 2005 to Sept 2007, PMMA was injected into the vertebrae of 35 cases （46 thoracic and lumbar vertebrae） guided by fluoroscopy. The image and clinical data after PVP were collected, and rotational DSA and three-dimensional reconstruction were performed postoperatively. The image and clinical data of PMMA cement extravasation were analysed, and were comfirmed by spiral CT scanning. Results Satisfactory distribution of cement was observed in 36 vertebrae of 28 cases （46 vertebrae） , while there was cement extravasation in 10 vertebrae of 7 cases. It was demonstrated by rotational DSA and spiral CT that cement extravasated into the adjacent intervertebral discs in 2 vertebrae, into the paravertebral soft tissue in 2 vertebrae and into the paravertebral venous plexus in 5 vertebrae. And it was revealed by lateral radiography that small amount of cement extended to the posterior vertebral margin in the other case, and was suspected extravasation into the spinal canal. While three-dimensional reconstructed images after rotational DSA and CT scanning demonstrated that PMMA located at the bilateral pedicle and no cement extravasated into the spinal canal. Conclusion Three-dimensional reconstructed images after rotational DSA can quickly determine the PMMA extravasation after PVP.