Advanced Medical Imaging and Genetics (Amigenics), 5495 South Rainbow Boulevard, Suite 201, Las Vegas, NV 89118, USA.
Eur J Radiol. 2012 May;81(5):960-7. doi: 10.1016/j.ejrad.2011.01.118. Epub 2011 Mar 1.
To evaluate the effect of vascular clips and endovascular coils placed for intracranial aneurysms and arteriovenous malformations on whole-brain computed tomography (CT) angiography and perfusion.
A 320-detector row dynamic volume CT system imaged 11 patients following surgical placement of vascular clips or endovascular coils. The extent of clip and coil subtraction by automated software was evaluated using CT digital subtraction angiography and CT perfusion. Impact on CT perfusion values by retained intracranial devices was compared to age- and gender-matched controls.
Clip and coil subtraction on CT angiography was graded as good in 8 and moderate in 3 cases. A residual neck and additional aneurysm were noted in 1 of 11 patients. Post-procedural axial slice level CT perfusion values decreased in reliability with increasing proximity to the metallic devices secondary to beam hardening. However, the intracranial devices did not affect axial slice level CTP values of cerebral blood volume, cerebral blood flow and mean transit time outside of the level of the device. Time to peak values was globally decreased outside of the immediate vascular intervention region.
Advances in CT technology have provided clinically useful subtraction of intracranial clips and coils. While CT perfusion values were altered in device subtraction areas and within beam hardening artifact areas; they can provide valuable postoperative information on whole-brain hemodynamics. In selected cases, the combination of CT angiography and whole-brain CT perfusion can offer an alternative to conventional angiography that is a more invasive option.
评估颅内动脉瘤和动静脉畸形血管夹和血管内线圈放置对全脑 CT 血管造影和灌注的影响。
使用 320 探测器层动态容积 CT 系统对 11 例接受血管夹或血管内线圈放置手术的患者进行成像。使用 CT 数字减影血管造影和 CT 灌注评估自动软件对夹和圈的减影程度。将颅内残留装置对 CT 灌注值的影响与年龄和性别匹配的对照组进行比较。
8 例 CT 血管造影夹和线圈减影评为良好，3 例评为中度。11 例患者中有 1 例发现残留颈部和额外动脉瘤。由于束硬化，金属器械的轴向切片水平 CT 灌注值随其与金属器械的接近程度的增加而逐渐降低。然而，颅内器械并不影响设备水平以外的脑血容量、脑血流量和平均通过时间的轴向切片水平 CTP 值。峰时间值在血管介入区域以外的整体降低。
CT 技术的进步为颅内夹和线圈的临床有用的减影提供了可能。虽然在器械减影区域和束硬化伪影区域的 CT 灌注值发生了改变；但它们可以为全脑血流动力学提供有价值的术后信息。在某些情况下，CT 血管造影和全脑 CT 灌注的结合可以为常规血管造影提供一种替代方法，常规血管造影是一种更具侵袭性的选择。
