高分辨平板CT在颅内Willis覆膜支架置入术中的应用价值研究  

Clinical value of high-resolution flat detector computed tomography in intracranial covered stent(Willis)implantation

作　　者：时程程 马骥[1] 朱明[1] 朱涛[1] 马宝 韩新巍[1] 李腾飞[1] Shi Chengcheng;Ma Ji;Zhu Ming;Zhu Tao;Ma Bao;Han Xinwei;Li Tengfei(Department of Interventional Radiology,First Affiliated Hospital,Zhengzhou University,Interventional Institute of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射介入科郑州大学介入治疗研究所,郑州450052

出　　处：《中华神经医学杂志》2020年第8期757-762,共6页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81801806)。

摘　　要：目的探讨高分辨平板CT在颅内Willis覆膜支架置入术中的应用价值。方法对郑州大学第一附属医院放射介入科自2017年6月至2019年8月收治的23例因颅内动脉瘤、椎动脉夹层或颈动脉海绵窦瘘而行颅内Willis覆膜支架置入术治疗的患者,使用DSA工作站对支架置入后普通平板CT和高分辨平板CT扫描结果分别进行后处理,比较不同方法显示的支架重建图像质量的差异;采用双容积重建融合技术将靶血管5s-3D-DSA重建图像和高分辨平板CT扫描的支架重建图像进行融合.观察并评估支架完全打开及贴壁情况。结果23例患者顺利置入25枚Willis覆膜支架.技术成功率达100%。与普通平板CT相比,高分辨平板CT能更清晰和直观地显示金属支架细节,图像质量评分有明显提高(0.56±0.71 v8.1.56±0.65),差异有统计学意义(P<0.05)。双容积重建融合技术观察到I枚支架头端金属丝U型连接处打折,但未见血管破裂及内漏等情况,余24枚支架完全打开并贴壁良好。结论高分辨平板CT能清晰展示支架打开程度及贴壁情况,进而指导术者采取相应的治疗策略,在颅内Willis覆膜支架置入术中具有较大的应用价值。Objective To evaluate the utility of high-resolution flat detector CT(HR-FDCT)in Willis covered stent implantation.Methods The clinical and imaging data of 23 patients with intracranial aneurysms,intracranial artery dissection or carotid-cavernous fistula treated by Willis covered stents in our hospital from June 2017 to August 2019 were retrospectively analyzed.Images were acquired using conventional FDCT and HR-FDCT;the differences of image quality for stent visualization were compared.Immediately after stent deployment,dual volume 3D fusion images were obtained from 5s-3D-digital subtraction angiography(DSA)and HR-FDCT,and the stent expansion status was also recorded.Results A total of 25 Willis covered stents were implanted in 23 patients with a success rate of 100%。As compared with that by FDCT,visualization of fine structures of the stent by HR-FDCT was improved,and the image quality by HR-FDCT was significantly improved as compared with that by FDCT(mean scores:0.56±0.71 vs.1.56±0.65,P<0.05).According to the reconstruction of 3D fusion images obtained from 3D-DSA combined with HR-FDCT,one stent was found to have poor apposition(the distal of the stent with kinking)without vascular rupture and internal leakage,and the other 24 stents were found lu lave guul appusitiun.Culclusius HR-FDCT couldl better display Willis covered stent details and afford improved image quality,which instructs surgeons to adopt appropriate treatment strategy.This novel HR-FDCT has great application potential in Willis covered stent implantation.

关 键 词：高分辨平板CT Willis覆膜支架 支架置入术 :双容积重建融合技术 

分 类 号：R651.1[医药卫生—外科学]