DSA仿真内镜成像在颈内动脉颅外段狭窄诊治中的作用

Effect of DSA virtual endoscopy in the diagnosis and treatment of extracranial internal carotid artery stenosis

目的探讨三维DSA仿真内镜成像在颈内动脉颅外段狭窄诊治中的价值。方法前瞻性收集南京医科大学附属淮安第一医院在2017年1月至2018年6月期间行DSA旋转造影和三维DSA仿真内镜成像的颈内动脉颅外段狭窄患者的临床及影像资料。DSA旋转造影图像通过球管和影像增强器的分两次同步旋转获得,应用InSpace软件对原始旋转图像进行三维重建。选择血管狭窄处,用Fly Through软件进行仿真内镜成像,观察血管腔内的结构情况。结果18个月内共有123例颈内动脉狭窄患者进行了DSA旋转造影和仿真内镜成像,118例患者第1次造影即获得了清晰的旋转造影和仿真内镜图像,5例患者因造影期间头部运动,成像不清晰,通过两次造影获得了清晰的图像。共发现171处血管狭窄,内膜形态光滑有116处,不光滑55处;斑块偏心的有114处,基本不偏心57处。95例患者行颈动脉支架置入术,手术成功率100%,术后残余狭窄率均<30%,预后良好。95例支架置入的患者均进行了三维DSA血管内镜随访,术后6个月首次随访时有81例患者的管腔已经光滑,支架骨架已经被内膜覆盖;术后12个月随访所有患者支架骨架均已被内膜覆盖。结论仿真三维DSA血管内镜成像是一种安全、有效的评估动脉管腔结构的方法,并可用于指导支架置入后个体化的抗血小板聚集治疗。

Objective To investigate the value of three-dimensional DSA virtual endoscopy in the diagnosis and treatment of extracranial internal carotid artery stenosis.Methods The clinical and imaging data of patients diagnosed as internal carotid artery stenosis and treated with DSA rotational angiography and 3 D virtual endoscopy between January 2017 and June 2018 in the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University were selected prospectively for this study.The rotate pictures were obtained by the twice synchronized rotation of bulb and an image enhancer.The original rotate images were performed three-dimensional reconstruction by using the InSpace software.The region of interest was selected,the Fly Through software was used for three-dimensional vascular endoscopic imaging and the endovascular structures were observed.Results During the 18 months period,123 carotid artery stenosis patients treated with DSA rotational angiography and virtual endoscopy were included.Among them,118 patients obtained clear rotational and virtual endoscopy images at the first angiography,5 patients obtained clear images by two angiograms because of head movement during angiography.There were 171 vascular stenosis,the intima morphology in 116 of them were smooth and in 55 of them were rough.The plaques were decentered in 114 stenosis and were almost non-eccentric in 57.Ninety-five patients underwent carotid artery stenting,and the technical success rate was 100%.The postoperative residual stenosis rate was less than 30%and their prognosis was good.All patients underwent stenting were followed up with three-dimensional DSA endoscopy.The vascular intima was covered completely and smooth in 81 patients at 6 months after surgery and was covered completely in all patients at 12 months after surgery.Conclusions The virtual vascular endoscopic imaging is a safe and effective method for evaluating the structures of carotid artery lumen.It also may be applied in guiding individualized antiplatelet aggregation drugs using after stenting.