高分辨率 C 臂 CT 联合条纹伪影消除技术在颅内动脉瘤支架辅助栓塞中的应用。
Application of High-Resolution C-Arm CT Combined with Streak Metal Artifact Removal Technology for the Stent-Assisted Embolization of Intracranial Aneurysms.
机构信息
From the Departments of Interventional Radiology (T.-F.L., J.M., X.-W.H., P.-J.F., J.-Z.R.).
Interventional Institute of Zhengzhou University (T.-F.L., J.M., X.-W.H., P.-J.F., J.-Z.R), Zhengzhou, China.
出版信息
AJNR Am J Neuroradiol. 2019 Oct;40(10):1752-1758. doi: 10.3174/ajnr.A6190. Epub 2019 Sep 26.
BACKGROUND AND PURPOSE
Metal artifacts from coils and stents limit the level of detail in C-arm CT images of stent attachment and coiling attenuation in the aneurysm neck. We evaluated the utility of high-resolution C-arm CT combined with streak metal artifact removal technology for stent-assisted embolization of intracranial aneurysms.
MATERIALS AND METHODS
From October 2017 to July 2018, the First Affiliated Hospital of Zhengzhou University treated 107 patients with intracranial aneurysms (118 aneurysms in total) with stent-assisted embolization. Conventional C-arm CT and high-resolution C-arm CT scanning of the stented area were performed during and after treatment. 3D images were reconstructed with and without streak metal artifact removal techniques. Subsequently, the image quality was compared. The reconstructed images indicated the stent deployment degree and packing density. Follow-up assessments included clinical and angiographic outcomes and complications.
RESULTS
In total, 118 aneurysms were successfully embolized using 118 stents. Image quality was significantly higher ( < .05) with high-resolution C-arm CT combined with streak metal artifact removal reconstruction. Streak metal artifact removal reconstruction and 2D angiography at working angles showed incomplete deployment of 6 stents and incomplete aneurysm embolization of 15 patients, which were subsequently resolved. One case of hemorrhage was noted postoperatively. Follow-up of 93 patients at 6-13 months indicated 3 cases of aneurysm recurrence.
CONCLUSIONS
High-resolution C-arm CT combined with the streak metal artifact removal technique effectively reduced metal artifacts from stents and coils during aneurysm embolization. This method can help physicians determine the extent of stent deployment and the packing density of coils and thus potentially reduce complications and aneurysm recurrence.
背景与目的
来自线圈和支架的金属伪影限制了 C 臂 CT 图像中支架附着和动脉瘤颈部线圈衰减的细节水平。我们评估了高分辨率 C 臂 CT 结合条纹金属伪影消除技术在颅内动脉瘤支架辅助栓塞中的应用。
材料与方法
自 2017 年 10 月至 2018 年 7 月，郑州大学第一附属医院采用支架辅助栓塞治疗颅内动脉瘤患者 107 例（共 118 个动脉瘤）。在治疗过程中和治疗后，对支架区域进行常规 C 臂 CT 和高分辨率 C 臂 CT 扫描。采用和不采用条纹金属伪影消除技术重建 3D 图像。随后，比较图像质量。重建图像显示了支架的展开程度和填充密度。随访评估包括临床和血管造影结果以及并发症。
结果
共成功栓塞 118 个动脉瘤，使用了 118 个支架。高分辨率 C 臂 CT 结合条纹金属伪影消除重建的图像质量显著提高（<.05）。条纹金属伪影消除重建和工作角度的 2D 血管造影显示，6 个支架不完全展开，15 个患者不完全栓塞动脉瘤，随后得到解决。术后出现 1 例出血。93 例患者随访 6-13 个月，发现 3 例动脉瘤复发。
结论
高分辨率 C 臂 CT 结合条纹金属伪影消除技术有效减少了动脉瘤栓塞过程中支架和线圈的金属伪影。该方法有助于医生确定支架展开的程度和线圈的填充密度，从而可能降低并发症和动脉瘤复发的风险。
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