术中超声血管造影技术在脑动静脉畸形切除术中的应用

Intraoperative real-time contrast-enhanced ultrasound angiography applied in the surgical treatment of arteriovenous malformations

目的探讨超声造影结合术中超声导航技术在AVM切除术中的应用价值。方法2006年9月至2006年12月,对3名经术前MRI及DSA检查确诊为AVM并且接受显微外科手术切除的患者。分别使用二维灰阶模式、CDFI模式、频谱多普勒模式以及超声造影技术进行术中扫查,通过各种数据分析,评价其应用价值。结果灰阶二维超声检查结果表明3例AVM病变在灰阶二维超声下都表现无明显边界的杂乱回声区。而在CDFI模式下表现为典型的"彩色镶嵌状"血管球,与周围正常组织间存在明显边界。静脉团注造影剂约24秒后开始显影。动脉系统先开始显影,包括正常脑动脉和病灶供血动脉;然后病灶和脑组织显影;最后为静脉系统显影。整个充盈过程表现为"动脉—毛细血管—静脉"的充盈规律。利用"爆破再充盈"技术可对多病灶进行多方向多切面扫查,完整了解病灶的血供模式。结论1.AVM术中使用超声造影技术,能实时观察造影剂微泡的充盈过程,其充盈符合"动脉-病灶-静脉"的规律,因此可以很好的区分供血动脉与引流静脉。2.利用"爆破再充盈"技术,可对病灶进行多方向多切面扫查。3.病灶切除后再次进行超声造影成像,能明确病灶切除是否完全,其结果与术后DSA检查一致。

Objective To investigate the diagnostic potential of contrast agents imaging combined with IOUS assisted in AVM surgical treatment. Methods From September, 2006 to December, 2006, three patients diagnosed as AVM comfirmed by preoperative MRI and DSA. The using gray-scale mode, color Doppler flow imaging （CDFI） and pulsed Doppler imaging in intraoperative guidance were used, and associated data was analyzed for investigating their value in AVM surgery. Based on these results, applying ultrasound contrast agents imaging in AVM surgery and discussed its value. Results Intraoperative ultrasound provided high-quality images in every case. Gray-scale imaging could not provide the identifiable boundary of AVM, whereas color Doppler flow imaging （CDFI） could clearly delineate the extent of AVM lesion. About 24 seconds after SonoVue bolus injection, real-time perfusion process of microbubbles could be observed, and with so-called ＂burst-refill＂ technique we could successfully identified the vascular anatomy of malformation lesions in multi-planes. Conclusion （1） By applying ultrasound contrast-specific imaging combined with IOUS, we can observe the real-time perfusion of microbubbles and its perfusion pattern followed ＂artery-tissue-vein procedures＂.（2） By applying so-called ＂burst-refill＂ technique, we can sweep AVM lesion in multi-sec- tion and can satisfactorily identify the vascular anatomy of lesion intraoperatively.（3） After resection, by injecting contrast agents again, we can assure the complete removal of lesions and its value is comparable to intraoperative DSA.