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标准二维超声与三维/四维超声及图像融合在腔内修复术后随访中测量主动脉瘤直径的比较

Standardized 2D ultrasound versus 3D/4D ultrasound and image fusion for measurement of aortic aneurysm diameter in follow-up after EVAR.

作者信息

Pfister Karin, Schierling Wilma, Jung Ernst Michael, Apfelbeck Hanna, Hennersperger Christoph, Kasprzak Piotr M

机构信息

Division of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany.

Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany.

出版信息

Clin Hemorheol Microcirc. 2016;62(3):249-60. doi: 10.3233/CH-152012.

Abstract

PURPOSE

To compare standardised 2D ultrasound (US) to the novel ultrasonographic imaging techniques 3D/4D US and image fusion (combined real-time display of B mode and CT scan) for routine measurement of aortic diameter in follow-up after endovascular aortic aneurysm repair (EVAR).

METHOD AND MATERIALS

300 measurements were performed on 20 patients after EVAR by one experienced sonographer (3rd degree of the German society of ultrasound (DEGUM)) with a high-end ultrasound machine and a convex probe (1-5 MHz). An internally standardized scanning protocol of the aortic aneurysm diameter in B mode used a so called leading-edge method. In summary, five different US methods (2D, 3D free-hand, magnetic field tracked 3D - Curefab™, 4D volume sweep, image fusion), each including contrast-enhanced ultrasound (CEUS), were used for measurement of the maximum aortic aneurysm diameter. Standardized 2D sonography was the defined reference standard for statistical analysis. CEUS was used for endoleak detection.

RESULTS

Technical success was 100%. In augmented transverse imaging the mean aortic anteroposterior (AP) diameter was 4.0±1.3 cm for 2D US, 4.0±1.2 cm for 3D Curefab™, and 3.9±1.3 cm for 4D US and 4.0±1.2 for image fusion. The mean differences were below 1 mm (0.2-0.9 mm). Concerning estimation of aneurysm growth, agreement was found between 2D, 3D and 4D US in 19 of the 20 patients (95%). Definitive decision could always be made by image fusion. CEUS was combined with all methods and detected two out of the 20 patients (10%) with an endoleak type II. In one case, endoleak feeding arteries remained unclear with 2D CEUS but could be clearly localized by 3D CEUS and image fusion.

CONCLUSION

Standardized 2D US allows adequate routine follow-up of maximum aortic aneurysm diameter after EVAR. Image Fusion enables a definitive statement about aneurysm growth without the need for new CT imaging by combining the postoperative CT scan with real-time B mode in a dual image display. 3D/4D CEUS and image fusion can improve endoleak characterization in selected cases but are not mandatory for routine practice.

摘要

目的

比较标准化二维超声(US)与新型超声成像技术三维/四维超声及图像融合(B 模式与 CT 扫描实时联合显示)在血管腔内主动脉瘤修复术(EVAR)后随访中对主动脉直径进行常规测量的效果。

方法与材料

由一名经验丰富的超声检查医师(德国超声协会(DEGUM)三级)使用高端超声仪和凸阵探头(1 - 5MHz)对 20 例 EVAR 术后患者进行 300 次测量。B 模式下主动脉瘤直径的内部标准化扫描方案采用所谓的前沿法。总之,使用了五种不同的超声方法(二维、三维徒手、磁场跟踪三维 - Curefab™、四维容积扫描、图像融合),每种方法均包括对比增强超声(CEUS),用于测量主动脉瘤的最大直径。标准化二维超声检查是用于统计分析的既定参考标准。CEUS 用于内漏检测。

结果

技术成功率为 100%。在增强横向成像中,二维超声测量的主动脉前后径(AP)平均值为 4.0±1.3cm,三维 Curefab™为 4.0±1.2cm,四维超声为 3.9±1.3cm,图像融合为 4.0±1.2cm。平均差异低于 1mm(0.2 - 0.9mm)。关于动脉瘤生长的评估,20 例患者中有 19 例(95%)的二维、三维和四维超声结果一致。图像融合总能做出明确诊断。CEUS 与所有方法联合使用,在 20 例患者中检测出 2 例(10%)II 型内漏。在 1 例中,二维 CEUS 未能明确内漏供血动脉,但三维 CEUS 和图像融合可清晰定位。

结论

标准化二维超声能够对 EVAR 术后主动脉瘤的最大直径进行充分的常规随访。图像融合通过在双图像显示中将术后 CT 扫描与实时 B 模式相结合,无需新的 CT 成像就能对动脉瘤生长做出明确判断。三维/四维 CEUS 和图像融合在某些情况下可改善内漏特征,但并非常规检查所必需。

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