CTA与DSA-DYNA-CT融合图像在腹主动脉瘤腔内修复术中的应用

Investigation of Clinical Application Using Fusion Imaging Combined CTA with DSA-DYNA-CT in the Endovascular Prosthesis for Abdominal Aortic Aneurysm

目的:评价利用CTA与DSA-DYNA-CT的融合图像作为腹主动脉瘤腔内修复术中的三维血管路径图的可行性。方法:腹主动脉瘤腔内修复术患者15例,术前行胸腹主动脉CTA检查,术中在腹主动脉瘤部位行数字平板DSA结合旋转断层重组技术所获得的CT样图像(DSA-DYNA-CT)的数据采集,在工作站中利用"syngo inspace 3D-fusion"功能进行两者图像融合,作为实时透视过程中的三维血管路径图。结果:CTA与DSA-DYNA-CT在融合过程中,10例骨性错位<2 mm,余5例手动调节后均骨性对位满意;肾动脉融合图像与实时透视的图像的位移较大,其中46.7%(7/15)的患者上下位移>2 mm),66.7%(10/15)的患者左右位移>2 mm。结论:将CTA与DSA-DYNA-CT的融合图像作为大血管的DSA三维血管路径图,在不用造影剂的情况下,可以在术中多角度观察导丝及支架与周围血管的位置关系。

Objective：To evaluate the DSA 3D-roadmap in the endovascular prosthesis for abdominal aortic aneurysm with the fusion image of CT angiography（CTA） and DSA-DYNA-CT. Methods：Fifteen patients with abdominal aortic aneurysm were enrolled in the study. Aortic CTA and DSA-DYNA-CT imaging were performed to the fusion imaging in the workstation with the software of syngo inspace 3D fusion for the abdominal aortic aneurysm without contrast medium administration. Then the fusion image was used as the 3D-roadmap in the process of real-time fluoroscopy. Results： In the fusion process of CTA and DYNA-CT, osseous paraposition were 〈2 mm in 10 cases, 3 cases 2-5 mm, 2 cases 〉 2 mm in 5 cases, but the osseous reg- istration can be satisfied with the manual adjustment （〈2mm）. Due to the influence of the stent delivery devices, the abdomi- nal aorta has marked displacement. Displacement was more than 2 mm between up and down in 7 cases （7/15,46.7%）, and displacement was greater than 2 mm between left and right in 10 patients （10/15,66.7%）. Conclusions： Without contrast me- dium administration, the 3D-roadmap, can be used to guide wire and to observe the stent position during the treatment of ab- dominal aortic aneurysm.