Cifarelli Christopher P, Vargo John A, Tenenholz Todd, Hack Joshua D, Guthrie Grenaville, Carpenter Jeffrey S
Neurological Surgery, West Virginia University School of Medicine/Ruby Memorial Hospital, Morgantown, USA.
Department of Radiation Oncology, West Virginia University School of Medicine, Morgantown, USA.
Cureus. 2018 Jun 11;10(6):e2788. doi: 10.7759/cureus.2788.
Background Gamma knife radiosurgery (GKRS) remains a critical intervention in the long-term management of arteriovenous malformations (AVMs). For planning a treatment, identification of the nidus is essential, and it is dependent on high-resolution blood flow imaging, usually in the form of a traditional angiogram. The development of dynamic 320-slice computed tomography (CT) angiography has offered a noninvasive alternative to intra-arterial fluoroscopic imaging, and it is capable of providing equivalent temporal resolution. In this study, we describe the feasibility of using four-dimensional CT angiography (4D-CTA) in GKRS planning for AVM treatment and a comparative analysis with a traditional angiogram. Methods A retrospective review was performed on AVM patients treated via GKRS with a 4D-CTA prior to the day of treatment, on the day of treatment, or with a day-of-treatment angiogram. Treatment times, along with total times in the Leksell® coordinate frame G, were obtained from the medical records. The frame-on time was calculated by subtracting the treatment time from the total time starting from application to removal, and the statistical analysis was performed across groups using analysis of variance (ANOVA). All treatments were performed on the Perfexion™ model with a dynamic flow imaging procured via a 320-slice CT scanner or traditional angiography platform. Results Some 27 patients underwent a total of 29 GKRS procedures for AVM treatment at our institution between September 2011 and January 2017. Mean age at the time of treatment was 35.5 (6-65) years, and male:female ratio was 5:4. Some 12 patients had 4D-CTA performed prior to the day of treatment, eight patients had the same CTA completed after frame placement on the day of treatment, while seven patients underwent traditional angiography. The mean frame-on times of each group were 190, 336, and 426 minutes, respectively (p < 0.0001). No procedures were aborted based on the image quality. Conclusions 4D-CTA is an effective tool in identifying the AVM nidus for GKRS planning. These studies can be performed prior to the day of treatment, allowing for a significant reduction in frame-on time and eliminating the risk of angiogram complication on the day of GKRS.
背景 伽玛刀放射外科手术（GKRS）仍是动静脉畸形（AVM）长期治疗中的关键干预手段。在制定治疗方案时，明确畸形血管团至关重要，这依赖于高分辨率血流成像，通常采用传统血管造影的形式。动态320层计算机断层扫描（CT）血管造影的发展为动脉内荧光透视成像提供了一种非侵入性替代方法，并且能够提供相当的时间分辨率。在本研究中，我们描述了在AVM治疗的GKRS计划中使用四维CT血管造影（4D-CTA）的可行性以及与传统血管造影的对比分析。方法 对在治疗前一天、治疗当天接受4D-CTA检查或在治疗当天接受血管造影检查并通过GKRS治疗的AVM患者进行回顾性分析。从病历中获取治疗时间以及在Leksell®坐标系G中的总时间。通过从应用到移除的总时间中减去治疗时间来计算框架开启时间，并使用方差分析（ANOVA）对各组进行统计分析。所有治疗均在Perfexion™型号上进行，使用通过320层CT扫描仪或传统血管造影平台获取的动态血流成像。结果 在2011年9月至2017年1月期间，我院共有27例患者接受了29次针对AVM治疗的GKRS手术。治疗时的平均年龄为35.5（6 - 65）岁，男女比例为5:4。12例患者在治疗前一天进行了4D-CTA检查，8例患者在治疗当天放置框架后完成了相同的CTA检查，而7例患者接受了传统血管造影检查。每组的平均框架开启时间分别为190、336和426分钟（p < 0.0001）。没有因图像质量而中止手术。结论 4D-CTA是在GKRS计划中识别AVM畸形血管团的有效工具。这些检查可在治疗前一天进行，从而显著减少框架开启时间并消除GKRS当天血管造影并发症的风险。
