二维和三维数字减影血管造影在 5mm 以下颅内小动脉瘤血管内弹簧圈栓塞治疗中的规划差异
Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms <5 mm.
机构信息
Department of Medical Imaging, Chi-Mei Medical Center, Tainan.
Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei.
出版信息
Interv Neuroradiol. 2020 Dec;26(6):733-740. doi: 10.1177/1591019920925706. Epub 2020 May 18.
BACKGROUND
To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire.
MATERIALS AND METHODS
Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: "Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?"; Question 2: "Is it achievable to secure the aneurysm with pure simple coiling?" The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated.
RESULTS
In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography.
CONCLUSIONS
Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.
背景
通过在线问卷调查，研究二维数字减影血管造影（2D-DSA）和三维旋转血管造影（3D-RA）在小（<5mm）脑动脉瘤中的差异，并评估其对神经介入专家决策的影响。
材料与方法
在 16 个二维或三维图像集中，视觉识别出 8 个破裂的小(<5mm)动脉瘤，将其放置在 11 位受邀神经介入专家的问卷调查中。对于每一组，提出两个问题：问题 1：“以下哪种治疗选择是首选：单纯弹簧圈、球囊重塑或支架辅助弹簧圈？”；问题 2：“单纯弹簧圈能否完全封闭动脉瘤？”评估二维数字减影血管造影与三维旋转血管造影的血管造影结构参数和治疗选择的差异。
结果
在所有 8 个病例中，三维旋转血管造影的瘤颈图像均大于二维数字减影血管造影，平均差值为 0.95mm。所有 8 个病例均用三维旋转血管造影进行分析，但仅有 1 个病例用二维数字减影血管造影分析，其被归类为瘤颈比<1.5 的宽颈动脉瘤。基于二维或三维信息的治疗选择在 88 对（63.6%）配对答案中存在差异。基于二维和三维信息，单纯弹簧圈分别是 66（75%）和 26（29.6%）答案的首选。提出了三种血管结构类型，即动脉瘤侧壁与母动脉之间的间隙较窄，以此解释三维旋转血管造影中瘤颈高估的原因。
结论
三维旋转血管造影中动脉瘤颈高估导致神经介入专家倾向于更复杂的治疗技术。对于小型脑动脉瘤的血管内治疗计划，额外的二维信息至关重要。
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