用于脑血管动态可视化的4D数字减影血管造影：26例单中心经验
4D DSA for Dynamic Visualization of Cerebral Vasculature: A Single-Center Experience in 26 Cases.
作者信息
Lang S, Gölitz P, Struffert T, Rösch J, Rössler K, Kowarschik M, Strother C, Doerfler A
机构信息
From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.).
出版信息
AJNR Am J Neuroradiol. 2017 Jun;38(6):1169-1176. doi: 10.3174/ajnr.A5161. Epub 2017 Apr 13.
BACKGROUND AND PURPOSE
4D DSA allows acquisition of time-resolved 3D reconstructions of cerebral vessels by using C-arm conebeam CT systems. The aim of our study was to evaluate this new method by qualitative and quantitative means.
MATERIALS AND METHODS
2D and 4D DSA datasets were acquired in patients presenting with AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA was compared with 2D DSA in a consensus reading of qualitative and quantitative parameters of AVMs (eg, location, feeder, associated aneurysms, nidus size, drainage, Martin-Spetzler Score), dural arteriovenous fistulas (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck configuration, aneurysmal size). Identifiability of perforators and diameters of the injection vessel (ICA, vertebral artery) were analyzed in 2D and 4D DSA. Correlation coefficients and a paired test were calculated for quantitative parameters. The effective patient dose of the 4D DSA protocol was evaluated with an anthropomorphic phantom.
RESULTS
In 26 patients, datasets were acquired successfully (AVM = 10, cerebral aneurysm = 10, dural arteriovenous fistula = 6). Qualitative and quantitative evaluations of 4D DSA in AVMs (nidus size: = 0.99, = .001), dural arteriovenous fistulas (diameter of the main feeder: = 0.954, = .03), and cerebral aneurysms (aneurysmal size: = 1, = .001) revealed nearly complete accordance with 2D DSA. Perforators were comparably visualized with 4D DSA. Measurement of the diameter of the injection vessel in 4D DSA was equivalent to that in 2D DSA ( = .039). The effective patient dose of 4D DSA was 1.2 mSv.
CONCLUSIONS
4D DSA is feasible for imaging of AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA offers reliable visualization of the cerebral vasculature and may improve the understanding and treatment of AVMs and dural arteriovenous fistulas. The number of 2D DSA acquisitions required for an examination may be reduced through 4D DSA.
背景与目的
4D DSA可通过使用C形臂锥束CT系统获取脑血管的时间分辨三维重建图像。本研究的目的是通过定性和定量方法评估这种新方法。
材料与方法
对患有动静脉畸形（AVM）、硬脑膜动静脉瘘和脑动脉瘤的患者采集二维和4D DSA数据集。在对AVM（如位置、供血动脉、相关动脉瘤、畸形瘤大小、引流情况、Martin-Spetzler分级）、硬脑膜动静脉瘘（如瘘口、主要供血动脉、主要供血动脉直径、引流情况）和脑动脉瘤（位置、瘤颈形态、动脉瘤大小）的定性和定量参数进行一致性解读时，将4D DSA与二维DSA进行比较。分析二维和4D DSA中穿支血管的可识别性以及注射血管（颈内动脉、椎动脉）的直径。计算定量参数的相关系数和配对检验。使用人体模型评估4D DSA方案的有效患者剂量。
结果
26例患者成功采集数据集（AVM = 10例，脑动脉瘤 = 10例，硬脑膜动静脉瘘 = 6例）。4D DSA对AVM（畸形瘤大小：r = 0.99，P = .001）、硬脑膜动静脉瘘（主要供血动脉直径：r = 0.954，P = .03）和脑动脉瘤（动脉瘤大小：r = 1，P = .001）的定性和定量评估显示与二维DSA几乎完全一致。4D DSA对穿支血管的显示效果相当。4D DSA中注射血管直径的测量结果与二维DSA相当（P = .039）。4D DSA的有效患者剂量为1.2 mSv。
结论
4D DSA对AVM、硬脑膜动静脉瘘和脑动脉瘤成像可行。4D DSA能可靠地显示脑血管系统，可能有助于提高对AVM和硬脑膜动静脉瘘的认识及治疗。通过4D DSA可减少检查所需的二维DSA采集次数。
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