Chen K-K, Guo W-Y, Yang H-C, Lin C-J, Wu C-H F, Gehrisch S, Kowarschik M, Wu Y-T, Chung W-Y
From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan.
Departments of Radiology (W.-Y.G., C.-J.L.)
AJNR Am J Neuroradiol. 2017 Apr;38(4):740-746. doi: 10.3174/ajnr.A5074. Epub 2017 Jan 26.
Time-resolved 3D-DSA (4D-DSA) enables viewing vasculature from any desired angle and time frame. We investigated whether these advantages may facilitate treatment planning and the feasibility of using 4D-DSA as a single imaging technique in AVM/dural arteriovenous fistula radiosurgery.
Twenty consecutive patients (8 dural arteriovenous fistulas and 12 AVMs; 13 men and 7 women; mean age, 45 years; range, 18-64 years) who were scheduled for gamma knife radiosurgery were recruited (November 2014 to October 2015). An optimal volume of reconstructed time-resolved 3D volumes that defines the AVM nidus/dural arteriovenous fistula was sliced into 2D-CT-like images. The original radiosurgery treatment plan was overlaid retrospectively. The registration errors of stereotactic 4D-DSA were compared with those of integrated stereotactic imaging. AVM/dural arteriovenous fistula volumes were contoured, and disjoint and conjoint components were identified. The Wilcoxon signed rank test and the Wilcoxon rank sum test were adopted to evaluate registration errors and contoured volumes of stereotactic 4D-DSA and integration of stereotactic MR imaging and stereotactic 2D-DSA.
Sixteen of 20 patients were successfully registered in Advanced Leksell GammaPlan Program. The registration error of stereotactic 4D-DSA was smaller than that of integrated stereotactic imaging ( = .0009). The contoured AVM volume of 4D-DSA was smaller than that contoured on the integration of MR imaging and 2D-DSA, while major inconsistencies existed in cases of dural arteriovenous fistula ( = .042 and 0.039, respectively, for measurements conducted by 2 authors).
Implementation of stereotactic 4D-DSA data for gamma knife radiosurgery for brain AVM/dural arteriovenous fistula is feasible. The ability of 4D-DSA to demonstrate vascular morphology and hemodynamics in 4 dimensions potentially reduces the target volumes of irradiation in vascular radiosurgery.
时间分辨三维数字减影血管造影（4D-DSA）能够从任何所需角度和时间框架观察血管系统。我们研究了这些优势是否有助于治疗计划制定，以及在动静脉畸形/硬脑膜动静脉瘘放射外科手术中使用4D-DSA作为单一成像技术的可行性。
招募了连续20例计划接受伽玛刀放射外科手术的患者（8例硬脑膜动静脉瘘和12例动静脉畸形；13例男性和7例女性；平均年龄45岁；范围18 - 64岁）（2014年11月至20l5年10月）。将定义动静脉畸形病灶/硬脑膜动静脉瘘的重建时间分辨三维容积的最佳容积切片成类似二维CT的图像。回顾性叠加原始放射外科治疗计划。将立体定向4D-DSA的配准误差与综合立体定向成像的配准误差进行比较。勾勒出动静脉畸形/硬脑膜动静脉瘘的容积，并识别出不相连和相连的部分。采用Wilcoxon符号秩检验和Wilcoxon秩和检验来评估立体定向4D-DSA的配准误差和勾勒容积以及立体定向磁共振成像与立体定向二维DSA的整合情况。
20例患者中有16例在先进的Leksell伽玛计划程序中成功配准。立体定向4D-DSA的配准误差小于综合立体定向成像的配准误差（P = 0.0009）。4D-DSA勾勒出的动静脉畸形容积小于磁共振成像与二维DSA整合时勾勒出的容积，而在硬脑膜动静脉瘘病例中存在主要不一致情况（两位作者进行测量时P分别为0.042和0.039）。
将立体定向4D-DSA数据用于脑动静脉畸形/硬脑膜动静脉瘘的伽玛刀放射外科手术是可行 的。4D-DSA在四个维度上显示血管形态和血流动力学的能力可能会减少血管放射外科手术中的照射靶体积。
