双容积重建技术在颅内宽颈动脉瘤介入栓塞术中的应用价值  

The application value of dual volume reconstruction in interventional embolization of wide necked intracranial aneurysms

作　　者：林宇佳 廖政贤[1] 张国栋 谢锋[1] 张文 LIN Yujia;LIAO Zhengxian;ZHANG Guodong;XIE Feng;ZHANG Wen(Interventional Operation Room,Meichou People's Hospital,Meizhou,Guangdong Province 514000,China)

机构地区：[1]梅州市人民医院介入手术室,广东梅州514000

出　　处：《实用放射学杂志》2019年第5期806-810,共5页Journal of Practical Radiology

基　　金：梅州市社会发展科技计划项目(2017B033)。

摘　　要：目的探讨双容积重建技术(DVRT)在颅内宽颈动脉瘤介入血管内栓塞术中的指导价值。方法收集梅州市人民医院介入手术室2017年6月至2017年12月颅内宽颈动脉瘤破裂出血的30例患者的临床及影像学资料,对应用DVRT介入治疗颅内宽颈动脉瘤的瘤颈栓塞效果、支架释放的位置及张开情况、术中相关并发症及术后6个月内随访复查进行回顾性分析。结果30例患者共有35枚动脉瘤(4例多发动脉瘤),支架辅助下26例,植入26枚支架,球囊辅助下4例。术后即刻行三维数字减影血管造影(3D-DSA)并在优势工作站(Advantage Workstation,AW)后处理工作站上行DVRT对图像进行评价。(1)26例动脉瘤致密栓塞,无瘤颈、瘤体残留(86.7%),3例动脉瘤瘤颈少许残留(10%),1例出现瘤体残留(0.33%);(2)26枚支架定位准确,完全释放(100%);(3)术中血管痉挛及支架内血栓2例,动脉瘤术中再次破裂1例;(4)术后6个月内行DSA复查:原26例致密栓塞者出现3例复发(11.5%),4例瘤颈残留及2例瘤体残留者中2例残留部分较前增多,其余无变化;26枚支架位置较前一致,3例出现支架内不同程度狭窄;(5)2D-DSA、3D-DSA和DVRT影像能清晰显示动脉瘤栓塞程度分别为20例(66.7%)、25例(83.3%)和30例(100%),3种成像方法显示的动脉瘤致密栓塞的程度差异有统计学意义(P<0.05)。结论颅内宽颈动脉瘤的介入栓塞术中及术后复查应用DVRT可以直观、清晰地显示动脉瘤的栓塞效果,支架释放的位置及与瘤颈的关系,为术者提供了一个评估动脉瘤栓塞情况、辅助支架展开情况及手术策略选择的客观依据。Objective To explore the value of dual volume reconstruction in interventional embolization of wide necked intracranialaneurysms.Methods The clinical and imaging data of 30 patients with intracranial wide neck aneurysm ruptured were collected from June 2016 to December 2017 in the Meizhou People's Hospital.The treatment of the intracranial wide necked aneurysm,the position and opening of the stent releasing,the related complications,and follow-up review after 6 months were retrospectively analyzed.Results Of the 30 patients,there were 35 aneurysms(4 multiple aneurysms),in which 26 cases were stents assisted,with 26 stents implanted,and 4 cases were balloon assisted.3D-DSA was performed immediately after operation and evaluated by dual volume reconstruction on Advantage Workstation(AW)post processing workstation.(1)26 cases of dense embolism of aneurysms without tumor neck or tumor residual(86.7%),3 cases of aneurysm cervical residual(10%)and 1 cases of tumor residual(0.33%);(2)26 stents with accurate locations and complete releases(100%).(3)2 cases with vasospasm and stent thrombosis during operation,and 1 case with second aneurysm rupture during operation.(4)DSA reexaminations in half a year after operations:3 cases recurred(11.5%)in the 26 cases of dense embolism;the residual in 2 cases increased in 4 of aneurysmal neck residual and 2 of tumor residual,and the rest remained;26 stents stayed in the same position and the stents in 3 cases were narrowed.2D-DSA,3D-DSA and dual volume reconstruction could clearly show the degree of embolization of aneurysms in 20 cases(66.7%),25 cases(83.3%)and 30 cases(100%),respectively.The degree of embolization of aneurysms was significantly different in three imaging methods(P<0.05).Conclusion In the process of interventional embolization for intracranial wide necked aneurysm,double volume reconstruction can be used to show the effect of embolization,the location of the stent and the relationship with the neck of the aneurysm,which provides an assessment of the situation of ane

关 键 词：宽颈动脉瘤 三维数字减影血管造影 双容积重建技术 残留动脉瘤 

分 类 号：R732.21[医药卫生—肿瘤] R815[医药卫生—临床医学]