三维数字减影血管造影血管虚拟内镜成像在颅内动脉瘤诊治中的作用  

Effect of 3D-DSA Vascular Virtual Endoscopic Imaging in the Treatment of Intracranial Aneurysm

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

机构地区：[1]北京大学第一医院神经外科,北京100034

出　　处：《中国微创外科杂志》2012年第10期925-929,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：教育部高等学校博士点基金(20110001120050);北京大学第一医院科研基金

摘　　要：目的探讨三维数字减影血管造影(three dimensional digital subtraction angiography,3D DSA)血管虚拟内镜成像在颅内动脉瘤诊治中的作用。方法回顾性分析53例颅内动脉瘤三维DSA血管虚拟内镜成像资料并应用三维DSA血管虚拟内镜成像随访术后载瘤血管及瘤颈残留情况。三维的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软件进行血管虚拟内镜成像,观察血管腔内结构。结果 53例术前三维DSA血管虚拟内镜成像清晰,共检出动脉瘤62个,其中动脉瘤体有穿支血管发出19例(15例手术证实),动脉瘤内有血栓形成7例(4例手术证实),载瘤动脉内有动脉粥样硬化斑块5例(3例手术证实)。术后31例3D DSA随访:28例未见瘤颈残留,2例出现载瘤动脉轻度狭窄;2例弹簧圈突入载瘤动脉血管腔内;1例动脉瘤栓塞后瘤颈复发残留,再次开颅夹闭动脉瘤。结论三维DSA血管虚拟内镜成像是一种安全有效的评估颅内动脉瘤管腔结构的方法,不仅可以用于动脉瘤的术前判断,指导手术方式的选择,也可以用于动脉瘤术后的随访,为明确术后载瘤动脉及瘤颈情况提供依据。Objective To investigate the effect of 3D-DSA vascular virtual endoscopic imaging in diagnosing and managing intracranial aneurysm. Methods 3D-DSA endoscopic imaging of preoperative intracranial aneurysm and postoperative aneurysm neck and parent arteries in 53 patients were retrospective analyzed. The 3D digital pictures were acquired by twice synchronized rotation of bulb and image enhancer. The original 3D image was reconstructed by Volume Viewer software. After fixing the density value and selecting the interested region, virtual endoscopic imaging was formed by Navigator software to observe intravascular conditions. Results 3D-DSA endoscopic imaging was successfully completed and was clear in all the patients. Totally 62 aneurysms were detected, including 19 cases of intracranial aneurysm complicated with perforating arteries （15 of the cases were confirmed by operation） , 7 cases of intracranial aneurysm complicated with thrombosis （4 of them were confirmed by operation） , and 5 cases of atherosclerosis plaque ifi the parent arteries （3 of them were confirmed by operation）. Follow-up was achieved in 31 of the patients, of which, 2 showed mild stricture of the parent artery, the other 28 patients showed no recurrence; 2 patients had the spring coil moved into the patent artery; and one patient had residual aneurysm neck and thus received a second operation to clip the lesion. Conclusions 3D-DSA vascular virtual endoscopic imaging is effective and safe in displaying the inner structure of intracranial aneurysm. It can be not only used in preoperative evaluation for aneurysm, helping to choose suitable treatment, but also to show the condition of aneurysm neck and parent artery during follow-up.

关 键 词：颅内动脉瘤 血管造影术 虚拟内镜成像 

分 类 号：R743[医药卫生—神经病学与精神病学]