Hirai Toshinori, Korogi Yukunori, Suginohara Kenji, Ono Ken, Nishi Tomohiro, Uemura Shozaburo, Yamura Masayuki, Yamashita Yasuyuki
Department of Radiology, Amakusa Medical Center, 854-1 Kameba, Hondo, Kumamato 863-0046, Japan.
AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1067-74.
Three-dimensional digital subtraction angiography (DSA) is useful as a supplement to 2D DSA in the pretreatment evaluation of intracranial aneurysms. However, the clinical efficacy of 3D digital angiography (DA) that is generated from unsubtracted rotational images has not been established. The purpose of this study was to assess whether 3D DA provides additional useful information to that of rotational DA in the preoperative evaluation of intracranial aneurysms.
This prospective study comprised 23 patients (age range, 37-83 years) with ruptured aneurysms who underwent angiography. Two radiologists independently evaluated the rotational DA images and the maximum intensity projection, shaded surface display, and volume-rendering 3D DA images, in combination with 2D DSA images. A four-point scoring system was used to evaluate aneurysm detection and delineation. Referring neurosurgeons were questioned as to whether the information obtained with 3D DA was useful for treatment decisions.
Thirty aneurysms were confirmed by surgery or endovascular treatment. In detection and delineation of the 30 confirmed aneurysms, overall mean scores were highest with volume-rendering 3D DA and lowest with rotational DA. Compared with rotational DA, volume-rendering 3D DA demonstrated 27 additional findings in 14 (47%) of 30 aneurysms: detection of an aneurysm (n = 2), and delineation of aneurysm neck, shape, and relationship to adjacent arteries (n = 25). The information provided by 3D DA was useful for following treatment in five (22%) of 23 patients.
In the preoperative evaluation of intracranial aneurysms, 3D DA can provide additional useful information to that of rotational DA.
三维数字减影血管造影（DSA）在颅内动脉瘤的预处理评估中作为二维DSA的补充很有用。然而，由未减影旋转图像生成的三维数字血管造影（DA）的临床疗效尚未确定。本研究的目的是评估三维DA在颅内动脉瘤术前评估中是否能提供比旋转DA更多的有用信息。
这项前瞻性研究包括23例（年龄范围37 - 83岁）破裂动脉瘤患者，他们接受了血管造影。两名放射科医生独立评估旋转DA图像、最大密度投影、表面阴影显示和容积再现三维DA图像，并结合二维DSA图像。采用四点评分系统评估动脉瘤的检测和描绘。询问神经外科会诊医生三维DA获得的信息是否对治疗决策有用。
30个动脉瘤经手术或血管内治疗得到证实。在检测和描绘这30个已证实的动脉瘤时，总体平均得分以容积再现三维DA最高，旋转DA最低。与旋转DA相比，容积再现三维DA在30个动脉瘤中的14个（47%）发现了另外27个情况：检测到一个动脉瘤（n = 2），以及描绘了动脉瘤颈部、形状及其与相邻动脉的关系（n = 25）。三维DA提供的信息对23例患者中的5例（22%）的后续治疗有用。
在颅内动脉瘤的术前评估中，三维DA能提供比旋转DA更多的有用信息。
