X线评估颅内动脉瘤介入治疗术后复发的临床研究  

Clinical research of X-ray plain film assessment of recurrence after interventional treatment of intracranial aneurysms

作　　者：汤伟[1] 李欢欢[1] 陈刚[1] 祝源[1] 赵曰圆[1] 盛柳青[1] 金二亮 李俊[1] 

机构地区：[1]南方医科大学武汉临床医学院,广州军区武汉总医院神经外科,武汉430070

出　　处：《中华神经外科杂志》2016年第2期140-143,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨颅内动脉瘤介入治疗术后采用普通x线透视随访的临床应用价值。方法回顾性分析2013年8月至2015年6月在广州军区武汉总医院神经外科行介入治疗并行数字减影血管造影（DSA）随访的所有颅内动脉瘤患者。要求同时具有术后即刻及复查工作位造影像（所有患者常规留取“0°／CRAN30°、LAO90°／0°’造影像），共有86例患者102个动脉瘤满足要求。搜集微弹簧圈x线透视像：术后即刻“工作位”、复查“工作位”、“0°／CRAN30°’和“LAO90°／0°’X线透视像，将术后即刻及随访的x线透视像中对应的投照角度记录的弹簧圈形态进行对比，判定弹簧圈形态是否变化。根据同一病例DSA结果判定动脉瘤是否复发。采用Kappa检验进行一致性分析。结果86例患者102个采用微弹簧圈栓塞的动脉瘤中，39个动脉瘤内弹簧圈形态有变化，DSA判定为复发；51个动脉瘤内弹簧圈形态无变化，DSA判定为未复发；3个动脉瘤内弹簧圈形态无变化，但DSA发现动脉瘤复发；9个动脉瘤内弹簧圈形态有变化，而DSA未见复发；总体准确率为88．2％，敏感性及特异性分别为92．9％和85．0％。采用Kappa检验，两种方法具有高度一致性（K=0．76，P〈0．05）。结论x线透视观察微弹簧圈的形态可以很好的预测动脉瘤是否复发，在颅内动脉瘤介入术后随访中具有较好的临床应用价值。Objective To investigate the clinical application value of using conventional X-ray fluoroscopy follow-up after interventional treatment of intracranial aneurysms. Methods From August 2013 to June 2015, all patients with intracranial aneurysm treated with interventional therapy and followed up with digital subtraction angiography （DSA） at the Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command were analyzed retrospectively. The patients were asked to have both immediately after procedure and reexamination operation position angiograms （all patients took conventional ＂O°/CRAN 30°＂ and ＂LAO 90°/0~＂ angiograms）. A total of 86 patients with 102 aneurysms met the demands. The shadowgraphs of the microcoils were collected： the immediately after procedure ＂operating position＂, reexamination ＂operation position＂, ＂O°/CRAN 30°＂, and ＂LAO 90°/0°＂ shadowgraphs. The coil shape documented with the corresponding projection angle were compared in the immediately after procedure and follow-up shadowgraphs and determined whether the coil shape changed or not. Whether the aneurysms recurrence or not were identified according to the DSA result of the same case. Kappa test was used to analyze the consistency. Results In 102 aneurysms using microcoil embolization, 90 coils did not have any change. DSA examination revealed no relapse. Under X-ray fluoroscopy, the coil shape did not have any change in 3 cases, but DSA revealed aneurysm recurrence. Under X-ray fluoroscopy, the coil shape changed in 9 cases, and DSA did not reveal recurrence. Using Kappa test, both methods were highly consistent （K = 0.76, P 〈0. 05）. Conclusions Observing microcoil shape with X-ray fluoroscopy can well predict whether aneurysms recurrence or not. It has better clinical application value in the follow-up after intracranial aneurysm intervention.

关 键 词：放射摄影术 颅内动脉瘤 栓塞 随访研究 

分 类 号：R743[医药卫生—神经病学与精神病学]