摘要
目的探讨三维容积重建技术(3D-VRT)在弹簧圈栓塞后颅内动脉瘤的DSA随访中的应用价值。方法采用介入弹簧圈栓塞技术治疗109例患者、共121枚颅内动脉瘤,术后所有患者均经历至少1次DSA随访。2名神经放射学专家分别对术后即刻和随访中的二维DSA造影(2D-DSA)、旋转血管造影(rotational angiography,RA)和3D-VRT成像进行分析,比较3种成像技术显示动脉瘤残留的能力。术后随访结果分为完全栓塞、瘤颈残留和瘤腔残留。若患者经历1次以上造影随访,评估最后一次随访结果。采用Kruskal-Wallis等级秩和检验对3种成像技术的评价结果进行比较,Kappa检验评价2名观察者结果的一致性。结果 121枚动脉瘤术后3D-VRT显示90枚完全栓塞,26枚瘤颈残留,5枚瘤腔残留。在随访造影中,2D-DSA发现完全栓塞、瘤颈残留和瘤腔残留分别为92枚、20枚和9枚,RA发现例数为86枚、23枚和12枚,3D-VRT为68枚、30枚和23枚,3组间比较差异有统计学意义(χ2=14.052,P=0.0009)。2名观察者对于2D-DSA、RA和3D-VRT观察结果的Kappa值分别为0.545、0.582和0.748。结论 3D-VRT技术能够明显提高DSA造影随访中动脉瘤残留的检出率,值得在栓塞动脉瘤的造影随访中推广使用。
Objective To discuss the clinical value of 3-dimensional volume-rendering technique（3D-VRT） in the follow-up checkups with DSA for intracranial aneurysms after embolization treatment.Methods One hundred and nine patients with a total of 121 intracranial aneurysms underwent endovascular embolization by using steel coils at our institution.All the patients were followed up with DSA at least one time.Two neuronradiologists separately evaluated the conventional 2-dimensional DSA（2D-DSA）,rotational angiography（RA） and 3D-VRT images obtained from the interventional procedure and follow-up DSA checkups.If several follow-up examinations were performed,only the final angiographic images were used.The abilities of 2D-DSAM,RA and 3D-VRT in detecting aneurysmal remnants,including neck remnant and aneurysmal sack remnant,were evaluated.The results were compared among the above three techniques.Kruskal-Wallis test was used for group comparisons,and Kappa test was used to measure inter-observer agreement.Results The immediate post-procedure 3D-VRT revealed that complete obliteration of the aneurysm was obtained in 90 cases,while neck remnant was found in 26 and sack remnant in 5 cases.Duringn the follow-up period,in 2D-DSA group complete obliteration,neck remnant and sack remnant were confirmed in 92,20 and 9 patients respectively,in RA group these were confirmed in 86,23 and 12 patients respectively,and in 3D-VRT group were confirmed in 68,30 and 23 patients respectively.The differences in detecting aneurysmal remnants among 2D DSA,RA and 3D VRT groups were statistical significant（χ2 = 14.052,P = 0.000 9）.The Kappa value for 2D-DSA,RA and 3D-VRT was 0.545,0.582 and 0.748,respectively.Conclusion 3D VRT can markedly improve the detectable rate of aneurysmal remnants.It is,therefore,recommended that this technique should be employed in clinical DSA follow-up checkups for the patients of intracranial aneurysms after embolization treatment.
出处
《介入放射学杂志》
CSCD
北大核心
2010年第10期762-766,共5页
Journal of Interventional Radiology
关键词
三维容积重建
数字减影血管造影
旋转造影
随访
3-dimentional volume-rendering technique
digital subtraction angiography
rotational angiography
follow-up
