3D旋转DSA在前列腺动脉栓塞术中的应用价值分析

Analysis of the application value of 3D rotational DSA in prostate artery embolization

目的探讨3D旋转DSA在前列腺动脉栓塞术(PAE)中的应用价值。方法选取2016年8月至2020年6月在我科行PAE治疗的良性前列腺增生(BPH)患者73例,所有患者行常规二维DSA(2D-DSA),以正位血管图像为重点,通过对C型臂旋转完成图像采集,将采集的图片发送到三维工作站,完成前列腺动脉血管重建。所有图片均由介入科2位具有高级职称的医师完成阅片,观察常规2D-DSA和3D旋转DSA成像中前列腺动脉数量、起源及与邻近动脉的吻合支。结果2位医师阅片识别前列腺动脉一致性的Kappa值为0.734。142侧髂内动脉,经常规2D-DSA和3D旋转DSA共准确识别前列腺动脉148支,其中,经3D旋转DSA准确识别前列腺动脉143支(96.62%,143/148),而经常规2D-DSA准确识别的为116支(78.38%,116/148),差异有统计学意义(χ^(2)=22.517,P<0.001);有26侧(18.31%,26/142)髂内动脉发出的28支前列腺动脉(18.92%,28/148)仅经3D旋转DSA识别,有4侧(2.82%,4/142)的4支(2.70%,4/148)仅经常规2D-DSA识别,差异有统计学意义(χ^(2)=20.182,P<0.001),经常规2D-DSA识别而被3D旋转DSA排除的前列腺动脉为6支(4.92%,6/122);9侧(6.16%,9/146)髂内动脉发出的10支前列腺动脉仅经3D旋转DSA准确识别其起源;经3D旋转DSA准确识别的前列腺动脉与邻近动脉存在吻合支的为57支(39.86%,57/143),高于常规2D-DSA的32支(27.59%,32/116),差异有统计学意义(χ^(2)=4.278,P=0.039);经对3D旋转DSA图像分析,143支前列腺动脉最佳投射角度(患者身体向同侧倾斜)为20°~45°,其中,61支(42.66%,61/143)前列腺动脉31°~35°投射角度最佳,26°~30°次之,为38支(26.57%,38/143)。结论3D旋转DSA应用于PAE术中,可更为清楚地识别前列腺动脉数量、起源及其复杂的解剖结构,从而对提高栓塞效果具有重要意义。

Objective To investigate the application value of 3D rotational DSA in prostate artery embolization(PAE).Methods A total of 73 cases of patients with benign prostatic hyperplasia(BPH)treated with PAE were selected in the Department of Interventional Therapy,The Fifth Affiliated Hospital of Zhengzhou University from August 2016 to June 2020.All patients were accepted conventional two-dimensional DSA(2D-DSA).Subsequently,focusing on the orthotopic blood vessel image,the image was acquired by rotating the C-arm,and the acquired imageswere sent to the 3D workstation to complete the reconstruction of the prostate artery.All pictures were reviewed by two physicians with advanced professional titles in the Department of Interventional Therapy.The number,origin,and anastomotic branch with adjacent arteries of the prostatic arteries in conventional 2D-DSA and 3D rotational DSA imaging were observed.Results The Kappa value of 2 doctors in the interventional department reading the film to identify the consistency of the prostate artery was 0.734.148 prostate arterieswere demonstrated in 142 lateral internal iliac arteries by conventional 2D-DSA and 3D rotational DSA.The 3D rotational DSAdemonstrated 143(96.62%,143/148),while the conventional 2D-DSA demonstrated 116(78.38%,116/148),the difference was statistically significant(χ^(2)=22.517,P<0.001).28(18.92%,28/148)prostate arteries in 26 lateral internal iliac arteries(18.31%,26/142)were only identified by the 3D rotational DSA,while 4(2.82%,4/142)in 4 lateral internal iliac arteries were only identified by the conventional 2D-DSA,the difference was statistically significant(χ^(2)=20.182,P<0.001).6(4.92%,6/122)prostate arteries were indentified by the conventional 2D-DSA while excluded by 3D rotational DSA.The origins of 10 prostate arteries in 9 lateral internal iliac arteries(6.16%,9/146)were only accurately identified by 3D rotational DSA.57 prostate arteries which were anastomose with adjacent arteries were accurately identified by 3D rotational DSA,which was higher than that of the conventional 2D-DSA(27.59%,32/116),the difference was statistically significant(χ^(2)=4.278,P=0.039).By analysis of 3D rotational DSA image,the optimal projection angle of 143 prostate arteries(the patient's body was inclined to the same side)was 20°~45°,among which,the optimal projection angle of 61(42.66%,61/143)prostate arterieswas31°~35°,and then was 26°~30°,which was 38(26.57%,38/143).Conclusions 3D rotational DSA applied in PAE surgery can more clearly identify the number and origin of prostate artery and its complex anatomical structure.Therefore,it is of great significance to improve the effect of embolization.