Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2013 Apr;76(4):218-24. doi: 10.1016/j.jcma.2012.12.009. Epub 2013 Mar 7.
Parametric-colored digital subtraction angiography using Tmax is almost a routine angiographic imaging procedure, currently. The current feasibility study is aimed to using the imaging to monitor treatment effects while embolizing indirect carotid-cavernous fistulas (CCF).
Ten patients with CCFs receiving embolization and 40 patients with normal circulation time were recruited. Their color-coded DSAs were used to define the Tmax of selected intravascular ROIs. A total of 19 ROIs in the internal carotid artery (ICA) (cervical segment of ICA in AP view (I0), cavernous segment of ICA in AP view (I1), supraclinoid segment of ICA in AP view (I2) and cervical segment of ICA in lateral view (I0'), cavernous portion of ICA in lateral view (IA), supraclinoid portion of ICA in lateral view (IB)), ACA (first segment of anterior cerebral artery, second segment of anterior cerebral artery (A1, A2)), middle cerebral vein (MCA) first segment of MCA ((M1), second segment of MCA (M2)), frontal vein (FV), parietal vein (PV), superior sagittal sinus (SSS), sigmoid sinus (SS), internal jugular vein (JV), fistula, superior ophthalmic vein (SOV), inferior petrosal vein (IPS), and MCV were selected. Relative Tmax was defined as the Tmax at selected ROIs minus Tmax at I0 or I0'. An intergroup comparison between the normal and treatment groups and pre- and post-treatment comparison of the peri-therapeutic rTmax for the treatment group were performed.
rTmax's for the normal group were as follows: Anterior-posterior view: I1: 0.16, I2: 0.32, A1: 0.31, M1: 0.35, SSS: 6.16, SS: 6.56, and MCV: 3.86 seconds. Lateral view: IA: 0.05, IB: 0.20, A2: 0.53, M2: 0.95, FV: 4.84, PV: 5.12, IPS: 4.62, JV: 6.81, and MCV: 3.86 seconds. Before embolization, rTmax of the IPS, SS, and JV for the treatment group were shortened (p < 0.05). No rTmaxs for any arterial ROIs in the fistula group were significantly different. After embolization, the rTmaxs for all venous ROIs returned to normal except for two which were partially obliterated.
This postprocessing method does not require extra radiation exposure and contrast media. It facilitates real-time hemodyamic monitoring and may help determining the endpoint of embolization, which increases patient safety.
目前，使用 Tmax 的参数彩色数字减影血管造影术几乎是一种常规的血管造影成像程序。本可行性研究旨在使用该成像技术监测间接颈动脉海绵窦瘘（CCF）栓塞治疗的效果。
招募了 10 例 CCF 患者接受栓塞治疗和 40 例正常循环时间的患者。他们的彩色编码数字减影血管造影术用于定义选定血管内感兴趣区域（ROI）的 Tmax。总共选择了 19 个 ROI，包括颈内动脉（ICA）（ICA 的颈段在前后位视图（I0）、ICA 的海绵窦段在前后位视图（I1）、ICA 的岩骨段在前后位视图（I2）和 ICA 的颈段在侧位视图（I0'）、ICA 的海绵窦段在侧位视图（IA）、ICA 的岩骨段在侧位视图（IB））、大脑前动脉的第一段（ACA）、大脑前动脉的第二段（A1、A2）、大脑中静脉的第一段（MCA）（M1）、MCA 的第二段（M2））、额静脉（FV）、顶静脉（PV）、上矢状窦（SSS）、乙状窦（SS）、颈内静脉（JV）、瘘管、眼上静脉（SOV）、岩下静脉（IPS）和 MCV。相对 Tmax 定义为所选 ROI 的 Tmax 减去 I0 或 I0'的 Tmax。对正常组和治疗组进行了组间比较，并对治疗组的治疗前和治疗后围治疗 rTmax 进行了比较。
正常组的 rTmax 如下：前后位：I1：0.16，I2：0.32，A1：0.31，M1：0.35，SSS：6.16，SS：6.56，MCV：3.86 秒。侧位：IA：0.05，IB：0.20，A2：0.53，M2：0.95，FV：4.84，PV：5.12，IPS：4.62，JV：6.81，MCV：3.86 秒。治疗组栓塞前 IPS、SS 和 JV 的 rTmax 缩短（p<0.05）。瘘管组任何动脉 ROI 的 rTmax 均无明显差异。栓塞后，除两个部分闭塞的静脉 ROI 外，所有静脉 ROI 的 rTmax 均恢复正常。
这种后处理方法不需要额外的辐射暴露和对比剂。它便于实时血流动力学监测，并有助于确定栓塞的终点，从而提高患者的安全性。
