仿真三维DSA血管内镜成像在颅内动脉狭窄诊治中的作用  

Effect of virtual vascular 3D-DSA endoscopic imaging in the diagnosis and treatment of intracranial arterial stenosis

作　　者：段鸿洲[1] 莫大鹏[1] 张扬[1] 伊志强[1] 李良[1] 张家涌[1] 鲍圣德[1] 

机构地区：[1]北京大学第一医院神经外科,100034

出　　处：《中国脑血管病杂志》2011年第8期407-411,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：北京大学第一医院科研基金

摘　　要：目的:探讨仿真三维DSA血管内镜成像在颅内动脉狭窄诊治中的价值。方法回顾性分析76例颅内动脉狭窄患者的三维DSA血管内镜成像资料,其中11例患者行颅内动脉支架置入术,并应用三维血管内镜随访其支架置入后血管腔内情况。三维旋转数字图像由脑血管造影机球管和影像增强器的同步2次240°旋转获得,应用Volume Viewer软件对原始三维图像进行重建,固定密度值并选取感兴趣区,用Navigator软件进行三维血管内镜成像,观察血管腔内的结构情况。结果①76例患者三维DSA血管内镜成像清晰,共114处血管狭窄,内膜形态光滑87处,不光滑27处;斑块偏心81处,基本不偏心33处。②对11例患者行颅内动脉支架置人术,技术成功率100%,术后残余狭窄率均<30%,预后良好。③三维DSA血管内镜随访支架置入的患者11例,术后6个月时7例患者的支架被内膜覆盖完全、光滑;术后12个月时10例患者的支架被内膜覆盖完全;术后18个月时1例患者的支架仍未被内膜完全覆盖。结论仿真三维DSA血管内镜成像是一种安全有效的评估颅内动脉管腔结构的方法,并可用于指导支架置入后抗血小板聚集药物的个体化治疗。Objective To investigate the value of virtual vascular 3D-DSA endoscopic imaging in the diagnosis and treatment of intracranial arterial stenosis. Methods The data of 3D-DSA endoscopic imaging in 76 patients with intracranial arterial stenosis were analyzed retrospectively. Eleven of the patients underwent intracranial artery stenting and a 3 D vascular endoscopy was used to follow up its endovascular conditions after stenting. The 3D rotate pictures were obtained by the twice synchronized rotation of bulb and an image enhancer for 240°rotation. The original 3D images were reconstructed using the Volume Viewer software. The density value was fixed and the region of interest was selected. Navigator software was used for 3D vascular endoscopic imaging and the endovascular structures were observed. Results （1）The 3D-DSA endoscopic imaging was clear in 76 patients. There were 114 vascular stenosis, the intima morphology in 87 of them were smooth and in 27 of them were rough. The plaques were decentered in 81 stenosis and were almost non-eccentric in 33. （2）11 patients underwent intracranial artery stenting, and the technical success rate was 100%. The postoperative residual stenosis rate was all 〈 30%, and their prognosis was good. （3）All paitents underwent stenting were followed up with 3D DSA endoscopic imaging. The vascular intimas were covered completely and smooth in 7 patients at 6 months after surgery and were covered completely in 10 patients at 12 months after surgery. Stentt in one patient remain exposed 18 months postoperatively. Conclusion The virtual vascular 3D-DSA endoscopic imaging is a safe and effective method for assessing the structures of intracranial artery lumen. It also may be applyed in guiding personal antiaggregation drug＇s using after stenting.

关 键 词：颅内动脉狭窄 血管造影术 仿真内镜 

分 类 号：R743.3[医药卫生—神经病学与精神病学]