三维影像融合在软脑膜动静脉瘘诊断与治疗中的应用价值

Application of 3D-images fusion to the diagnosis and treatment of pial AVFs

目的探讨三维影像融合在软脑膜动静脉瘘(p AVF)诊断与治疗中的应用价值。方法回顾性分析三家医院2014年9月到2015年2月收治的5例p AVF患者的临床资料。患者三维影像在Siemens Artis Zee Biplane双大平板DSA机的SystemSyngo X-WP三维后处理工作站上应用融合软件自动融合。分析3D-DSA双血管融合、CT/MR影像融合、3D-DSA/Dyna-CT影像融合,用于协助诊断与实施血管内治疗。从供血动脉、瘘口形态和位置、引流静脉及动静脉瘘与相邻脑结构的空间关系这4个方面来评价三维影像融合对诊断与治疗的应用价值。结果 3D-DSA双血管、MR/CT及3D-DSA/Dyna-CT等三维影像融合,可以把3D-DSA提供的血管系统信息与MR影像或Dyna-CT影像信息通过后处理融合在一张图像上,实现同步可视,将病变的双重血供和病变与脑组织、颅神经及颅骨的解剖关系显示清楚。5例患者的3D-DSA双血管、MR/CT或3D-DSA/Dyna-CT影像融合比未融合资料在对上述4个方面的评估上更具有价值,对诊断和手术更有意义。结论三维融合影像更有助于对p AVF进行术前评估和设计手术计划,特别是有助于术前更好地理解病变的解剖特点和对栓塞材料的选择。

Objective To explore the application of three dimensional（3D） images fusion including dual vessel 3D-DSA imagesfusion, 3D-DSA and MR images fusion and 3D-DSA and Dyna-CT images fusion to the diagnosis and treatment of intracranial pialarteriovenous fistulas（AVFs）.MethodsThe 3D-DSA and MR images of 5 patients with pial AVFs were automatically fused by fusionsoftware on System Syngo X-WP 3D post-processing workstation of Siemens Artis zee biplane DSA machine. The informations providedby Dual vessels 3D images fusion, 3D-DSA and MR images fusion, and 3D-DSA and Dyna-CT images fusion were analyzed in order tohelp diagnosis and endovascular treatment.ResultsThe arteries feeding to the pial AVF, veins draining from the pial AVFs, morphologyand location of the fistulas, and relationships between the pial AVF and the adjacent normal brain structures showed by 3D imagesfusion were clearer than those only by 3D-DSA or MRA and MR images or Gyna-CT images in all the patients with pial AVF, in whom,all the pial AVFs were successfully embolized endovascularly.ConclusionsThe 3D fusion images are very helpful to the definitediagnosis and making the plan for treatment of the pial AVFs, especially to neurosurgeons to understand the surgical anatomy and choosepreoperatively material for the endovascular embolization.