DSA容积成像对支架进行精细显影在神经介入治疗中的应用  

Application of DSA volumetric imaging technology in achieving high-precision visualization of stents in neurointerventional treatment

作　　者：陈迎春 冯娟娟 方艳 盛柳青 叶建锋 别毕洲 汪志忠 张青 王声播 李俊 CHEN Ying-chun;FENG Juan-juan;FANG Yan;SHENG Liu-qing;YE Jian-feng;BIE Bi-zhou;WANG Zhi-zhong;ZHANG Qing;WANG Sheng-bo;LI Jun(Department of Neurosurgery,The Third People's Hospital of Hubei Province Affiliated to Jianghan University(Institute of Cerebrovascular Disease,Jianghan University),Wuhan 430033,China)

机构地区：[1]江汉大学附属湖北省第三人民医院神经外科(江汉大学脑血管病研究所),武汉430033

出　　处：《中国临床神经外科杂志》2024年第11期646-649,共4页Chinese Journal of Clinical Neurosurgery

基　　金：湖北省卫生健康委指导性项目(WJ2021F139,WJ2019F176);湖北省自然科学基金(2023AFCO32)。

摘　　要：目的 探讨DSA容积成像对支架进行精细显影在神经介入治疗中的应用效果。方法 回顾性分析2021年4月至2022年6月支架植入术治疗的68例脑血管病的临床资料。在支架释放过程中或完全释放后,应用DSA容积成像对支架进行小视野扫描,然后对影像进行去金属伪影等后处理并三维重建,评价支架显影效果及释放后状态,其中支架精细结构显示清晰评定为显影效果优,可明确识别支架轮廓,但不能清晰显示支架精细结构评定为显影效果良,不能明确识别支架轮廓评定为显影效果差,并反馈术者对支架治疗方法进行调整改进。结果 68例共使用71枚支架,其中Enterprise支架48枚、Neuroform EZ支架1枚、Neuroform Atlas支架8枚、Lvis支架5枚、Leo支架1枚,Tubridge支架8枚;显影效果优55枚,显影效果良12枚,显影效果差4枚;优良率为94.4%。DSA容积成像可清晰显示Enterprise支架、Neuroform EZ支架、Neuroform Atlas支架、Lvis支架、Leo支架等精细结构。由于Tubridge支架的编曲网眼细、密及编织丝相互的伪影干扰,DSA容积成像不能清晰显示其精细网眼结构,但对其可显影金属丝的重建效果良好,可清晰显示支架全程轮廓。导致支架精细显影效果差的最主要因素是弹簧圈的金属伪影。结论在使用支架治疗脑血管病时,DSA容积成像可精准判断支架植入后张开、贴壁、打折等状态,对低可视性支架也有良好显示效果,是评价治疗效果的重要依据。Objective To investigate the application efficacy of DSA volumetric imaging technology in achieving high-precision visualization of stents during neurointerventional treatment.Methods A retrospective analysis was performed on the clinical data of 68 patients with cerebrovascular diseases who underwent stent implantation from April 2021 to June 2022.During or after the complete release of the stents,DSA volumetric imaging technology was employed for small-field scanning,and post-processing such as metal artifact removal and three-dimensional reconstruction were conducted on the images to evaluate the visualization effect of the stents and their post-release status.The specific evaluation criteria were as follows:clear display of the fine structure of the stent was rated as excellent in visualization effect;clear identification of the stent contour but not the fine structure was rated as good in visualization effect;inability to clearly identify the stent contour was rated as poor in visualization effect.The visualization results were fed back to the neurosurgeons to facilitate the adjustment and improvement of the stent treatment methods.Results A total of 71 stents were utilized,including 48 Enterprise stents,1 Neuroform EZ stent,8 Neuroform Atlas stents,5 Lvis stents,1 Leo stent,and 8 Tubridge stents.Among them,55 stents had excellent visualization effects,12 had good visualization effects,and 4 had poor visualization effects,with an excellent and good rate of 94.4%.DSA volumetric imaging could clearly display the fine structures of Enterprise,Neuroform EZ,Neuroform Atlas,Lvis,and Leo stents.However,due to the fine mesh and mutual interference of the braided wires of the Tubridge stent,its fine mesh structure could not be clearly displayed,but the reconstruction effect of its metal wires was favorable,and the entire contour of the stent could be clearly displayed.The main factor contributing to the poor fine visualization of the stent was the metal artifact of the coils.Conclusion When using stents to treat cere

关 键 词：脑血管病 介入治疗 DSA容积成像 支架精细显影 

分 类 号：R743[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]