3D-DSA联合roadmap技术在脑血管疾病介入诊治中的应用价值  

Clinical application of three-dimensional DSA combined with roadmap technique in diagnosis of cerebral vascular diseases

作　　者：陈建华[1] 段传志[2] 刘亚杰[3] 张炘[2] 彭志康[1] 刘亚洪[1] 汪求精[2] 何旭英[2] 黎凯锋[3] 贺雄军[3] 

机构地区：[1]南方医科大学珠江医院介入中心,广东广州510282 [2]南方医科大学珠江医院神经外科,广东广州510282 [3]南方医科大学珠江医院神经内科,广东广州510282

出　　处：《生物医学工程与临床》2015年第3期245-251,共7页Biomedical Engineering and Clinical Medicine

基　　金：广东省科技计划项目(2012B031800131)

摘　　要：目的探讨三维数字减影血管造影（3D-DSA）联合路径图（roadmap）技术在脑血管病诊断及治疗中的应用价值。方法选择169例脑血管病患者,其中男性96例,女性73例;年龄6~81岁,平均年龄49.31岁。全部病例进行DSA及血管内介入治疗,按其治疗过程分为2组：第一组104例全部行3D-DSA及2D-DSA检查并联合roadmap治疗,分析颅内动脉瘤、脑动静脉畸形（AVM）及脑动脉狭窄在3D-DSA上的影像学表现,并与2D-DSA比较;第二组65例全部行2D-DSA检查并在roadmap指示下行介入治疗,与第一组3D-DSA检查并结合roadmap治疗过程进行比较。结果在诊断方面：3D-DSA在动脉瘤检出率和瘤颈判别上与2D-DSA比较,3D-DSA对动脉瘤准确率比2D-DSA高16.3%（7/43）,对动脉瘤瘤颈的显示比2D-DSA高48.2%,对AVM供血动脉、畸形血管团构筑显示方面二者差异亦有统计学意义（P〈0.05）,对血管内斑块形态的显示3D-DSA比2D-DSA高30.7%,对血管狭窄率的精确测量3D-DSA比2DDSA高42.3%。在治疗方面：3D-DSA联合roadmap技术与2D-DSA联合roadmap技术相比较,在手术时间与X射线曝光时间上,差异有统计学意义（P〈0.05）,在roadmap成像次数、造影剂用量和X射线辐射剂量方面的差异均有统计学意义（P〈0.05）。结论与传统2D-DSA相比,3D-DSA联合roadmap技术在脑血管疾病影像诊断及介入治疗中的成像次数、造影剂用量、X射线剂量、手术时间和X射线曝光时间等方面具有重要的应用价值。Objective To discuss the application value of three-dimensional digital subtraction angiography（3D-DSA） combined with roadmap technology in diagnosis and therapy for cerebral vascular disease. Methods A total of 169 patients with cerebral vascular disease were enrolled, which included 73 males and 57 females; aged 6- 81 years old with mean age of 49.31 years old.All of them were performed by DSA and endovascular treatment, and divided into 2 groups accorded to treatment process. The first group（n = 104） received 3D-DSA and 2D-DSA examination which combined with roadmap treatment to identify features of aneurysm, arteriovenous malformations（AVM） and artery stenosis in image exposure of 3D-DSA, and compared results with those of 2D-DSA. The second group（n = 65） was received 2D-DSA examination and interventional treatment, which also combined with roadmap treatment to compare with 3D-DSA examination combined roadmap treatment in first group. Results In aneurysmal neck detection rate, the accurate rate of 3D-DSA aneurysm was higher 16.3 %（7/43） than that of 2D-DSA, the exposure of aneurysmal neck was higher 48.2 % than that of 2D-DSA. There were significant statistic differences in blood flow pattern of AVM artery and vascular malformation construction（P 〈 0.05）. The exposure of intravascular plaque by 3D- DSA was higher 30.7 % than that of 2D-DSA, and accurate measurement of blood vessels stenosis of 3D-DSA was higher 42.3 % than that of 2D-DSA. In treatment, there was significant statistic difference（P 〈 0.05） in operation time and X-ray exposure time between3D-DSA combined with roadmap technology and 2D-DSA combined with roadmap technology. And there were significant statistic differences between 3D-DSA and 2D-DSA in roadmap image times, image volume dose and X-ray radiation dosage（ P 〈0.05）. Conclusion It is demonstrated that compared with traditional 2D-DSA, the 3D-DSA combined with roadmap technique in cerebrovascular disease has more important application value in diagnosi

关 键 词：三维数字减影血管造影(3D-DSA) ROADMAP 二维数字减影血管造影(2D-DSA) 颅内动脉瘤 脑动静脉畸形 脑动脉狭窄 

分 类 号：R743.3[医药卫生—神经病学与精神病学]