Asakura Fumio, Tenjin Hiroshi, Sugawa Noriaki, Kimura Satoshi, Oki Fumiya
Department of Neurosurgery, Kyoto Prefectural Yosanoumi Hospital, Kyoto, Japan.
Surg Neurol. 2003 Apr;59(4):310-9; discussion 319. doi: 10.1016/s0090-3019(02)01045-5.
The natural course of cerebral aneurysms is related to many factors, and it is very important that intra-aneurysmal blood flow is considered. Our group developed a method that allowed the simultaneous evaluation of blood flow in human cerebral aneurysms using digital subtraction angiography (DSA) with no special devices. The intra-aneurysmal blood flow measurement would also be very useful for coil embolization. Since the Guglielmi detachable coil (GDC) was developed, many patients with cerebral aneurysm have been treated with GDC, but coil compaction has sometimes caused a problem after the coil embolization of a cerebral aneurysm. We believed that an intra-aneurysmal flow measurement would suggest the final result of embolization during the procedure.
We performed DSA to examine 17 aneurysms in 17 patients. The video signal of serial DSA images was stored on a personal computer, and time-density curves were obtained for each individual pixel. The formula, determined by a two-exponential model, was fitted to the time-density curve 1000 times by least square approximation for each individual pixel. We indirectly substituted the coefficient of the flow-in curve for the blood flow. We were therefore able to display the distribution of intra-aneurysmal blood flow in color. We could compare the blood flow in each portion of the cerebral aneurysm and parent artery during coil embolization.
The blood flow k(a) in a small aneurysm was faster than that in a large aneurysm, and it slowed in accordance with the coil embolization. The blood flow in a large aneurysm was sometimes accelerated by incomplete coil embolization.
We can detect the flow distribution in cerebral aneurysms and the flow change during coil embolization, using existing equipment. Our method would be useful in elucidating the natural history of cerebral aneurysms, treating cerebral aneurysms with coils, and following patients after treatment.
脑动脉瘤的自然病程与多种因素相关，考虑瘤内血流情况非常重要。我们团队开发了一种方法，可使用数字减影血管造影（DSA）在无需特殊设备的情况下同时评估人脑动脉瘤内的血流。瘤内血流测量对于弹簧圈栓塞也非常有用。自从 Guglielmi 可脱性弹簧圈（GDC）问世以来，许多脑动脉瘤患者接受了 GDC 治疗，但弹簧圈致密化有时会在脑动脉瘤弹簧圈栓塞后引发问题。我们认为瘤内血流测量可在手术过程中提示栓塞的最终结果。
我们对 17 例患者的 17 个动脉瘤进行了 DSA 检查。将连续 DSA 图像的视频信号存储在个人计算机上，为每个像素获取时间 - 密度曲线。由双指数模型确定的公式，通过最小二乘法对每个像素的时间 - 密度曲线进行 1000 次拟合。我们间接将流入曲线的系数代入以计算血流。因此，我们能够以彩色显示瘤内血流分布。我们可以比较脑动脉瘤弹簧圈栓塞过程中动脉瘤各部分和载瘤动脉内的血流情况。
小动脉瘤内的血流 k(a) 比大动脉瘤内的快，并且随着弹簧圈栓塞而减慢。大动脉瘤内的血流有时会因弹簧圈不完全栓塞而加速。
我们可以使用现有设备检测脑动脉瘤内的血流分布以及弹簧圈栓塞过程中的血流变化。我们的方法对于阐明脑动脉瘤的自然病程、用弹簧圈治疗脑动脉瘤以及治疗后随访患者将是有用的。
