Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan; Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France.
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
World Neurosurg. 2019 Nov;131:e176-e185. doi: 10.1016/j.wneu.2019.07.109. Epub 2019 Jul 19.
The flow dynamics of the intracranial venous channels are fundamentally important for understanding intracranial physiology and pathophysiology. However, the method clinically applicable to the evaluation of the flow dynamics of the intracranial venous system has not been well described in the reported data. We have developed a new method to evaluate intracranial venous flow direction and velocity using 4-dimensional (4D) computed tomography angiography (CTA). The aim of the present study was to verify the accuracy and validity of 4D-CTA in a clinical setting.
We retrospectively analyzed 97 veins from 26 patients (16 cases of arteriovenous shunt disease, 9 intracranial tumor cases, and 1 cerebral aneurysm case) who had undergone both 4D-CTA and conventional digital subtraction angiography (DSA). Using 4D-CTA, we analyzed the time-density curve with gamma distribution extrapolation and obtained the direction of the flow and flow velocity of each vein. The direction of the flow in 4D-CTA was also collated with that obtained using conventional DSA to verify the experimental method.
The direction of the flow determined by 4D-CTA was consistent with that of conventional DSA in 94.8% of cases. The average venous flow velocity was 64.3 mm/second and 81.8 mm/second, respectively, in the antegrade and retrograde channels affected by arteriovenous shunts.
The present flow analysis using 4D-CTA enabled us to evaluate the direction and velocity of intracranial venous flow. Other than some limitations, the presented method is reliable and its potential for application in clinical settings is promising.
颅内静脉通道的流动动力学对于理解颅内生理学和病理生理学至关重要。然而，在已报道的数据中，尚未很好地描述临床应用于评估颅内静脉系统流动动力学的方法。我们已经开发了一种使用 4 维（4D）计算机断层血管造影（CTA）评估颅内静脉血流方向和速度的新方法。本研究的目的是在临床环境中验证 4D-CTA 的准确性和有效性。
我们回顾性分析了 26 例患者（动静脉分流疾病 16 例，颅内肿瘤 9 例，脑动脉瘤 1 例）的 97 条静脉，这些患者均同时接受了 4D-CTA 和常规数字减影血管造影（DSA）检查。使用 4D-CTA，我们通过伽马分布外推分析时间密度曲线，获得每条静脉的血流方向和流速。通过比较 4D-CTA 中的血流方向与常规 DSA 中的血流方向，验证了实验方法。
在 94.8%的病例中，4D-CTA 确定的血流方向与常规 DSA 一致。受动静脉分流影响的顺行和逆行通道的平均静脉血流速度分别为 64.3mm/秒和 81.8mm/秒。
本研究使用 4D-CTA 进行的血流分析能够评估颅内静脉的血流方向和速度。除了一些局限性外，该方法可靠，在临床环境中的应用具有广阔的前景。
