Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
J Neurosurg. 2010 Mar;112(3):674-80. doi: 10.3171/2009.7.JNS081718.
The authors conducted a study to evaluate the advantages of a 3D volume-rendering technique (VRT) in follow-up digital subtraction (DS) angiography of coil-embolized intracranial aneurysms.
One hundred nine patients with 121 intracranial aneurysms underwent endovascular coil embolization and at least 1 follow-up DS angiography session at the authors' institution. Two neuroradiologists independently evaluated the conventional 2D DS angiograms, rotational angiograms, and 3D VRT images obtained at the interventional procedures and DS angiography follow-up. If multiple follow-up sessions were performed, the final follow-up was mainly considered. The authors compared the 3 techniques for their ability to detect aneurysm remnants (including aneurysm neck and sac remnants) and parent artery stenosis based on the angiographic follow-up. The Kruskal-Wallis test was used for group comparisons, and the kappa test was used to measure interobserver agreement. Statistical analyses were performed using commercially available software.
There was a high statistical significance among 2D DS angiography, rotational angiography, and 3D VRT results (X(2) = 9.9613, p = 0.0069) when detecting an aneurysm remnant. Further comparisons disclosed a statistical significance between 3D VRT and rotational angiography (X(2) = 4.9754, p = 0.0257); a high statistical significance between 3D VRT and 2D DS angiography (X(2) = 8.9169, p = 0.0028); and no significant difference between rotational angiography and 2D DS angiography (X(2) = 0.5648, p = 0.4523). There was no statistical significance among the 3 techniques when detecting parent artery stenosis (X(2) = 2.5164, p = 0.2842). One case, in which parent artery stenosis was diagnosed by 2D DS angiography and rotational angiography, was excluded by 3D VRT following observations of multiple views. The kappa test showed good agreement between the 2 observers.
The 3D VRT is more sensitive in detecting aneurysm remnants than 2D DS angiography and rotational angiography and is helpful for identifying parent artery stenosis. The authors recommend this technique for the angiographic follow-up of patients with coil-embolized aneurysms.
作者开展了一项研究，旨在评估三维容积再现技术（VRT）在颅内动脉瘤弹簧圈栓塞后数字减影血管造影（DS）随访中的优势。
作者所在机构对 109 例 121 个颅内动脉瘤患者进行了血管内弹簧圈栓塞，并至少进行了 1 次随访性 DS 血管造影检查。2 位神经放射科医生分别独立评估介入治疗过程中获得的常规二维 DS 血管造影、旋转血管造影和三维 VRT 图像，以及 DS 血管造影随访时的图像。如果进行了多次随访，主要考虑最后一次随访。根据血管造影随访结果，作者比较了这 3 种技术检测动脉瘤残瘤（包括瘤颈和瘤腔残瘤）和载瘤动脉狭窄的能力。采用 Kruskal-Wallis 检验进行组间比较，kappa 检验评估观察者间一致性。统计分析采用商业软件进行。
在检测动脉瘤残瘤方面，二维 DS 血管造影、旋转血管造影和三维 VRT 结果之间存在统计学显著差异（X(2) = 9.9613，p = 0.0069）。进一步比较显示，三维 VRT 与旋转血管造影之间存在统计学显著差异（X(2) = 4.9754，p = 0.0257）；三维 VRT 与二维 DS 血管造影之间存在统计学显著差异（X(2) = 8.9169，p = 0.0028）；旋转血管造影与二维 DS 血管造影之间无统计学显著差异（X(2) = 0.5648，p = 0.4523）。在检测载瘤动脉狭窄方面，3 种技术之间无统计学显著差异（X(2) = 2.5164，p = 0.2842）。有 1 例患者，载瘤动脉狭窄通过二维 DS 血管造影和旋转血管造影诊断，但通过多视图观察排除了三维 VRT。kappa 检验显示，2 位观察者之间具有良好的一致性。
三维 VRT 比二维 DS 血管造影和旋转血管造影更敏感，能更好地检测动脉瘤残瘤，有助于识别载瘤动脉狭窄。作者推荐该技术用于弹簧圈栓塞动脉瘤患者的血管造影随访。
