School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2019 May;82(5):396-400. doi: 10.1097/JCMA.0000000000000046.
Quantitative digital subtraction angiography (DSA) facilitates in-room assessment of flow changes in various cerebrovascular diseases and improves patient safety. The purpose of this study was to compare the diagnostic accuracy of quantitative fluoroscopic angiography (FA) and DSA.
Twenty-two patients with >70% carotid stenosis according to NASCET criteria were prospectively included in the study. All patients received DSA and FA (ArtisZee, Siemens Healthcare, Forchheim, Germany) before and after carotid stenting in the same angiosuite. The regions of interest (ROIs) included the extracranial internal carotid artery (eICA), first segment of the middle cerebral artery (MCA1), and sigmoid sinus in the anterior-posterior view; cavernous portion of the ICA (cICA), parietal vein, and jugular vein in the lateral views. The time-to-peak (TTP) for all ROIs and cerebral circulation time (CCT) were measured from FA and DSA scans. TTP, CCT, and radiation doses from DSA were compared with those from FA.
The mean age of the patients were 69 ± 9.5 years old. The average stenosis was 89.7% ± 7.8% before stenting and 31% ± 3.6% after stenting. No patient suffered from periprocedural stroke. The intermethod correlation for TTP for all ROIs except the eICA and cICA ranged from 0.46 to 0.65 before stenting and 0.57 to 0.73 after stenting, and that for CCT was 0.65 before stenting and 0.57 after stenting. The radiation doses were significantly lower for FA than for DSA regardless of views or periprocedural timing (p < 0.001).
Stenosis facilitated the creation of a bolus by manual injection and therefore increased the accuracy of cerebral flow quantification in FA. Cerebral hemodynamic assessment by FA is quicker and associated with less radiation.
定量数字减影血管造影（DSA）有助于在各种脑血管疾病中进行即时评估血流变化，提高患者安全性。本研究旨在比较定量荧光血管造影（FA）和 DSA 的诊断准确性。
前瞻性纳入 22 例根据 NASCET 标准存在>70%颈动脉狭窄的患者。所有患者在同一血管造影室内接受颈动脉支架置入术前和术后的 DSA 和 FA（西门子医疗公司的 ArtisZee，德国 Forchheim）。感兴趣区（ROI）包括颅外颈内动脉（eICA）、大脑中动脉第一段（MCA1）和前后位的乙状窦；ICA 海绵窦段（cICA）、顶静脉和侧位的颈内静脉。从 FA 和 DSA 扫描中测量所有 ROI 的达峰时间（TTP）和脑循环时间（CCT）。比较 DSA 和 FA 的 TTP、CCT 和辐射剂量。
患者平均年龄为 69±9.5 岁。支架置入前平均狭窄率为 89.7%±7.8%，支架置入后为 31%±3.6%。无患者发生围手术期卒中。支架置入前，除 eICA 和 cICA 外，所有 ROI 的 TTP 以及 CCT 的 TTP 之间的方法间相关性在 0.46 到 0.65 之间，支架置入后为 0.57 到 0.73 之间，CCT 的 TTP 之间的相关性为 0.65 到 0.57 之间。无论视图或围手术期时间如何，FA 的辐射剂量均显著低于 DSA（p<0.001）。
狭窄通过手动注射方便了造影剂团的形成，从而提高了 FA 中脑血流定量的准确性。FA 进行的脑血流动力学评估更快，且辐射剂量更低。
