3D-DSA及2D-DSA在颅内动脉瘤介入栓塞术中的对照研究

发布时间：2019-04-16 17:40

【摘要】：目的评估二维数字减影血管造影(2D-DSA)及三维数字减影血管造影(3D-DSA)对颅内动脉瘤介入栓塞术中诊断及治疗上的成像差异,评价2D-DSA及3D-DSA二种方法对颅内动脉瘤的诊疗价值,为临床工作提供指导。方法回顾性分析242例动脉瘤介入栓塞术病人,使用西门子公司的脑血管造影系统,经股动脉行脑血管造影,对比剂使用碘普罗胺。2D-DSA常规拍摄双侧颈内动脉及至少一侧椎动脉的正位和侧位像,必要时加入斜位像,造影剂注入速度为4ml/s。3D-DSA通过旋转C臂180度,每秒采集6帧图像,512*512矩阵。注药流率:颈内动脉5ml/s,总量9ml,椎动脉4ml/s,总量8ml。所采集图像数据传到workstation工作站进行重建,后重建出3D-DSA图像。重建方法采用容积再现显示法。收集完整的2D-DSA及3D-DSA影像资料,比较两种成像方法对动脉瘤的检出率、瘤颈与载瘤血管、穿通血管毗邻关系,介入栓塞术后动脉瘤瘤颈残留情况。两种方法的动脉瘤检出率比较,采用四格表χ2检验,动脉瘤颈与载瘤动脉关系比较,使用行乘列χ2检验,检验结果均应用SPSS 17.0软件进行统计评价,P0.05为差异有统计学意义。结果2D-DSA及3D-DSA两种检测方法,在动脉瘤的检出率(86.4%VS 100%),瘤颈与载瘤血管、穿通血管毗邻关系的显示(38.4%VS 90.1%,0 VS 10.7%),术后瘤颈残留评估(0.4%VS7.8%),3D-DSA效果明显优于2D-DSA(P0.05)。结论3D-DSA在动脉瘤检出率、对术前情况分析和术后效果评估优于2D-DSA,因此3D-DSA可作为动脉瘤诊疗的“金标准”。
[Abstract]:Objective to evaluate the difference between two-dimensional digital subtraction angiography (2D-DSA) and three-dimensional digital subtraction angiography (3D-DSA) in the diagnosis and treatment of intracranial aneurysms during interventional embolization. To evaluate the value of 2D-DSA and 3D-DSA in the diagnosis and treatment of intracranial aneurysms and to provide guidance for clinical work. Methods A retrospective analysis of 242 patients undergoing interventional embolization of aneurysms was performed by using Siemens cerebral angiography system and femoral artery angiography. Contrast media were used with iodopropylamine. 2D-DSA routinely took positive and lateral images of the bilateral internal carotid artery and at least one side of the vertebral artery, adding oblique images if necessary. The injection rate of the contrast medium was 180 degrees through the rotation of the C arm of the 4ml/s.3D-DSA. Capture 6 frames of images per second, 512 x 512 matrix. Injection rate: internal carotid artery (5 ml / ml), total volume (9 ml), vertebral artery (4 ml / ml), total amount (8 ml / ml). The collected image data was transmitted to workstation for reconstruction, and then the 3D-DSA image was reconstructed. The reconstruction method was volume reproduction display method. The complete 2D-DSA and 3D-DSA images were collected to compare the detection rate of aneurysms, the adjacent relationship between the neck and the bearing vessels and perforating vessels, and the residual status of the aneurysm neck after interventional embolization. The detection rate of aneurysms in the two methods was compared. Four tabular 蠂 2 test was used to compare the relationship between the aneurysm neck and the bearing artery, and the multiplicative 蠂 2 test was used. The results of the test were statistically evaluated by SPSS 17.0 software. P0.05 was statistically significant. Results the detection rate of 2D-DSA and 3D-DSA was 100% in aneurysm (86.4%VS 100%), and the adjacent relationship between the neck of aneurysm and the bearing vessel and perforating vessel was shown (38.4%VS 90.1%, 0 VS 10.7%). Postoperative evaluation of tumor neck residue (0.4% vs 7.8%) showed that 3D-DSA was better than 2D-DSA (P0.05). Conclusion 3D-DSA is superior to 2D DSA in the detection rate, preoperative analysis and postoperative evaluation of aneurysms. Therefore, 3D-DSA can be used as the "gold standard" for the diagnosis and treatment of aneurysms.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

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