Safain Mina G, Rahal Jason P, Patel Samir, Lauric Alexandra, Feldmann Edward, Malek Adel M
Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center, and Tufts University School of Medicine, Boston, Massachusetts.
J Neurosurg. 2014 Aug;121(2):441-9. doi: 10.3171/2014.5.JNS132201. Epub 2014 Jun 20.
Intracranial atherosclerotic disease (ICAD) carries a high risk of stroke. Evaluation of ICAD has focused on assessing the absolute degree of stenosis, although plaque morphology has recently demonstrated increasing relevance. The authors provide the first report of the use of ultra-high-resolution C-arm cone-beam CT angiography (CBCT-A) in the evaluation of vessel stenosis as well as plaque morphology.
Between August 2009 and July 2012, CBCT-A was used in all patients with ICAD who underwent catheter-based angiography at the authors' institution (n = 18). Lesions were evaluated for maximum degree of stenosis as well as plaque morphological characteristics (ulcerated, calcified, dissected, or spiculated) via digital subtraction angiography (DSA), 3D-rotational angiography (3DRA), and CBCT-A. The different imaging modalities were compared in their assessment of absolute stenosis as well as their ability to resolve different plaque morphologies.
Lesions were found to have similar degrees of stenosis when utilizing CBCT-A compared with 3DRA, but both 3DRA and CBCT-A differed from DSA in their assessment of the absolute degree of stenosis. CBCT-A provided the most detailed resolution of plaque morphology, identifying a new plaque characteristic in 61% of patients (n = 11) when compared with DSA and 50% (n = 9) when compared with 3DRA. CBCT-A identified all lesion characteristics visualized on DSA and 3DRA.
CBCT-A provides detailed spatial resolution of plaque morphology and may add to DSA and 3DRA in the evaluation of ICAD. Further prospective study is warranted to determine any benefit CBCTA-A may provide in clinical decision making and risk stratification over existing conventional imaging modalities.
颅内动脉粥样硬化性疾病（ICAD）具有较高的中风风险。ICAD的评估一直侧重于评估狭窄的绝对程度，尽管斑块形态最近显示出越来越重要的相关性。作者首次报告了使用超高分辨率C型臂锥束CT血管造影（CBCT-A）评估血管狭窄以及斑块形态。
2009年8月至2012年7月期间，作者所在机构对所有接受导管血管造影的ICAD患者（n = 18）使用了CBCT-A。通过数字减影血管造影（DSA）、三维旋转血管造影（3DRA）和CBCT-A评估病变的最大狭窄程度以及斑块形态特征（溃疡、钙化、夹层或毛刺状）。比较了不同成像方式在评估绝对狭窄以及分辨不同斑块形态方面的能力。
与3DRA相比，使用CBCT-A时发现病变的狭窄程度相似，但3DRA和CBCT-A在评估绝对狭窄程度方面与DSA不同。CBCT-A提供了最详细的斑块形态分辨率，与DSA相比，在61%的患者（n = 11）中发现了一种新的斑块特征，与3DRA相比为50%（n = 9）。CBCT-A识别出了DSA和3DRA上显示的所有病变特征。
CBCT-A提供了详细的斑块形态空间分辨率，在ICAD评估中可能补充DSA和3DRA。有必要进行进一步的前瞻性研究，以确定CBCT-A在临床决策和风险分层方面可能比现有的传统成像方式提供哪些益处。
