SINTEF Health Research, Trondheim, Norway.
Neurosurgery. 2009 Dec;65(6 Suppl):149-57; discussion 157. doi: 10.1227/01.NEU.0000345945.92559.C5.
The objective of this study was to investigate the clinical applicability of navigated blood flow imaging (BFI) in neurovascular applications. BFI is a new 2-dimensional ultrasound modality that offers angle-independent visualization of flow. When integrated with 3-dimensional (3D) navigation technology, BFI can be considered as a first step toward the ideal tool for surgical needs: a real-time, high-resolution, 3D visualization that properly portrays both vessel geometry and flow direction.
A 3D model of the vascular tree was extracted from preoperative magnetic resonance angiographic data and used as a reference for intraoperative any-plane guided ultrasound acquisitions. A high-end ultrasound scanner was interconnected, and synchronized recordings of BFI and 3D navigation scenes were acquired. The potential of BFI as an intraoperative tool for flow visualization was evaluated in 3 cerebral aneurysms and 3 arteriovenous malformations.
The neurovascular flow direction was properly visualized in all cases using BFI. Navigation technology allowed for identification of the vessels of interest, despite the presence of brain shift. The surgeon found BFI to be very intuitive compared with conventional color Doppler methods. BFI allowed for quality control of sufficient flow in all distal arteries during aneurysm surgery and made it easier to discern between feeding arteries and draining veins during surgery for arteriovenous malformations.
BFI seems to be a promising modality for neurovascular flow visualization that may provide the neurosurgeon with a valuable tool for safer surgical interventions. However, further work is needed to establish the clinical usefulness of the proposed imaging setup.
本研究旨在探讨导航血流成像（BFI）在神经血管应用中的临床适用性。BFI 是一种新的二维超声模式，可提供角度独立的血流可视化。当与三维（3D）导航技术集成时，BFI 可以被视为满足手术需求的理想工具的第一步：实时、高分辨率、3D 可视化，能够正确描绘血管几何形状和血流方向。
从术前磁共振血管造影数据中提取血管树的 3D 模型，并将其用作术中任何平面引导超声采集的参考。高端超声扫描仪被互联，并获取 BFI 和 3D 导航场景的同步记录。在 3 个脑动脉瘤和 3 个动静脉畸形中评估了 BFI 作为术中血流可视化工具的潜力。
在所有病例中，BFI 都能正确显示神经血管的血流方向。尽管存在脑移位，但导航技术仍允许识别感兴趣的血管。与传统的彩色多普勒方法相比，外科医生发现 BFI 非常直观。BFI 允许在动脉瘤手术中对所有远端动脉进行足够的血流质量控制，并使在动静脉畸形手术中更容易区分供血动脉和引流静脉。
BFI 似乎是一种很有前途的神经血管血流可视化方法，可为神经外科医生提供一种更安全手术干预的有价值工具。然而，需要进一步的工作来确定所提出的成像设置的临床有用性。
