3D影像融合技术用于腔内介入治疗主动脉病变

3D image fusion technology in endovascular interventions of aortic diseases

目的分析3D影像融合技术用于腔内介入治疗主动脉病变的价值。方法回顾性分析18例接受3D影像融合引导腔内介入治疗主动脉病变患者。于Siemens Artis Pheno工作站以Syngo-X-workshop软件将术前主动脉CT血管造影(CTA)与术中锥形束CT(CBCT)图像进行融合,分别于T10~L3椎体水平进行冠状位、矢状位及轴位3个维度的配对融合,将最终形成的3D融合影像投射至实时数字减影血管造影(DSA)影像中,用于导引主动脉腔内介入操作。记录治疗用时、碘对比剂用量及射线剂量等。结果18例中,腹主动脉瘤7例、主动脉穿透性溃疡5例、胸主动脉夹层4例、胸主动脉瘤2例;对11例行腹主动脉瘤腔内修复术(EVAR)、7例行胸主动脉腔内修复术(TEVAR),均获得成功,技术成功率100%;治疗用时(124.28±55.95)min,碘对比剂用量(178.89±37.87)ml,辐照时间(20.21±13.20)min,CBCT辐射剂量(225.17±60.10)mGy,总辐射剂量(815.68±439.10)mGy。7例术前合并肾功能不全,术后24 h、出院前及术后1、3个月血肌酐值与术前比较差异均无统计学意义(P均>0.05)。结论3D影像融合技术用于腔内介入治疗主动脉病变安全、可行。

Objective To explore the value of 3 D image fusion technology in endovascular interventions of aortic diseases. Methods Data of 18 patients who underwent 3 D image fusion-guided endovascular interventions of aortic diseases were retrospectively analyzed. Images of preoperative CT angiography(CTA) of the aorta and intraoperative cone beam CT(CBCT) were fused at Siemens Artis Pheno workstation with Syngo-X-workshop software. 3 D fusion images for intraoperative navigation were generated through images paired fusing in three dimensions(coronal, sagittal and axial, T10—L3) and projected into real-time digital subtraction angiography(DSA) for guiding interventional procedures. The operation time, dosage of iodine contrast agent and radiation dose etc. were collected. Results Among 18 patients, there were 7 cases of abdominal aortic aneurysms, 5 cases of penetrating aortic ulcers, 4 cases of thoracic aortic dissection and 2 cases of thoracic aortic aneurysms. Totally 11 patients underwent endovascular aortic aneurysm repair(EVAR) and 7 underwent thoracic endovascular aortic repair(TEVAR). All operations were successfully performed, and the technical success rate was 100%. The operation time was(124.28±55.95)min, the dose of iodine contrast agent was(178.89±37.87)ml, and the irradiation time was(20.21±13.20)min. The radiation dose of CBCT was(225.17±60.10)mGy, and the total radiation dose of the operation was(815.68±439.10)mGy. In 7 patients with preoperative renal insufficiency, there was no significant difference of serum creatinine 24 h after operation, before discharge, 1 and 3 months after operation compared with that before operation(all P>0.05). Conclusion 3 D image fusion technology was safe and feasible in endovascular interventions of aortic diseases.