高分辨率对比增强锥形束CT在颅内支架成形术后评估中的应用价值

Application of high resolution contrast enhanced cone beam CT in post-cranial stent plasty evaluation

目的:探讨高分辨率对比增强锥形束CT(VasoCT)在评估颅内动脉支架植入术后支架贴壁、内膜增生及支架内血栓情况的应用价值。方法:回顾性搜集2019年11月至2021年10月在昆明医科大学第一附属医院因颅内动脉瘤行支架植入治疗术后3个月复查患者共32例,对比分析三维DSA、常规XperCT、VasoCT及VasoCT结合去金属伪影(MAR)技术对支架植入后支架贴壁、内膜增生及支架内血栓的显示情况,结果由2位神经介入医师对图像质量进行综合量化评分。结果:32例患者共植入34枚支架,单纯Pipline支架植入23例(双支架植入2例),Pipline支架辅助弹簧圈栓塞动脉瘤患者7例,LVIS及Solitaire支架辅助弹簧圈栓塞各1例。所有患者术后3个月均成功进行随访。VasoCT在评估支架贴壁、内膜增生、支架内血栓等方面优于三维DSA及常规XperCT(P<0.001)。VasoCT结合去金属伪影(MAR)技术可更清晰显示支架与弹簧圈、靶血管的关系。结论:VasoCT能清晰显示颅内支架贴壁、内膜增生及支架内血栓情况;对支架辅助弹簧圈栓塞动脉瘤患者,VasoCT结合MAR技术评估支架情况具有独特优势。

Objective:To investigate the application value of high resolution contrast-enhanced cone-beam CT(VasoCT)in the evaluation of stent apposition,intimal hyperplasia and stent thrombosis after intracranial arterial stenting.Methods:A total of 32 patients who underwent stent implantation for intracranial aneurysms in the First Affiliated Hospital of Kunming Medical University from November 2019 to October 2021 were retrospectively reviewed three months after surgery.The conditions of stent apposition,intimal hyperplasia and stent thrombosis after stent implantation were compared and analyzed by three-dimensional DSA,conventional XperCT,VasoCT and VasoCT combined with metal artifact removal(MAR).The image quality was comprehensively quantitatively scored by two neurointerventional physicians.Results:A total of 34 stents were implanted in 32 patients,including 23 patients with Pipline alone(2 patients with dual stents implantation),seven patients with Pipline-assisted coil embolization,and one patient with LVIS and one patient with Solitaire-assisted coil embolization.All patients were successfully followed up three months after surgery.VasoCT was significantly superior to 3D DSA and conventional XperCT in the evaluation of stent apposition,intimal hyperplasia and stent thrombosis(P<0.001).VasoCT combined with MAR can more clearly show the relationship between stent,coil and target vessels.Conclusion:VasoCT can clearly show intracranial stent apposition,intimal hyperplasia and stent thrombosis.For patients with stent-assisted coil embolization of intracranial aneurysms,VasoCT combined with MAR has unique advantages in stent evaluation.