Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Minato-ku, Tokyo, Japan.
Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Minato-ku, Tokyo, Japan; Department of Neurosurgery, University California Irvine School of Medicine, Irvine, California, USA.
World Neurosurg. 2021 Mar;147:e388-e395. doi: 10.1016/j.wneu.2020.12.068. Epub 2021 Jan 7.
To investigate flow diverter (FD) apposition on fused images acquired by high-resolution cone-beam computed tomography (CBCT) and 3-dimensional (3D) digital subtraction angiography.
Patients with large or giant internal carotid artery aneurysms treated with Pipeline FDs who underwent CBCT imaging at our institution between October 2016 and May 2019 were included. Two neurosurgeons measured the maximum malapposition between FDs and vessel walls on 3D fusion images of high-resolution CBCT images displaying the FD and 3D digital subtraction angiography images displaying the vessels. Associations between the relative malapposition, FD diameter, vessel diameter, proximal and distal vessel diameter discrepancy, and siphon angle were evaluated by linear regression analysis. Inter-rater and intermethod (3D and 2D image) agreements of the malapposition measurements were assessed by Bland-Altman analysis and by interclass correlation coefficients.
Images of 2 patients were excluded because of image artifacts or fusion errors, and 3D fusion images were acquired in the remaining 26 patients. Our results did not suggest that relative malapposition was associated with vessel diameter (P = 0.12), vessel diameter discrepancy (P = 0.60), or syphon angle (P = 0.34), but relative malapposition increased by an estimated 13% (95% confidence interval: 4%-23%, P = 0.006) for each 1 mm increase in FD diameter. Inter-rater and intermethod agreements for apposition measurements were excellent and good, respectively.
Three-dimensional fusion images provided clear visualization of structures of both the stent and parent artery with excellent diagnostic reliability. Careful deployment may be needed for FDs with larger diameters, as they tended to have larger relative malapposition.
研究使用高分辨率锥形束计算机断层扫描（CBCT）和三维（3D）数字减影血管造影（DSA）获得的融合图像上的血流导向装置（FD）贴壁情况。
纳入 2016 年 10 月至 2019 年 5 月在我院接受 Pipeline FD 治疗的大型或巨大颈内动脉动脉瘤患者。由 2 名神经外科医生在 FD 与血管壁之间的最大错位的 3D 融合图像上进行测量，该融合图像由显示 FD 的高分辨率 CBCT 图像和显示血管的 3D DSA 图像组成。通过线性回归分析评估相对错位、FD 直径、血管直径、近端和远端血管直径差异以及虹吸角度之间的相关性。通过 Bland-Altman 分析和组内相关系数评估贴壁测量的组内和组间（3D 和 2D 图像）一致性。
由于图像伪影或融合错误，排除了 2 例患者的图像，其余 26 例患者获得了 3D 融合图像。我们的结果表明，相对错位与血管直径（P=0.12）、血管直径差异（P=0.60）或虹吸角度（P=0.34）无关，但 FD 直径每增加 1mm，相对错位估计增加 13%（95%置信区间：4%-23%，P=0.006）。贴壁测量的组内和组间一致性分别为极好和良好。
3D 融合图像可清晰显示支架和母动脉的结构，具有极好的诊断可靠性。对于直径较大的 FD，可能需要小心放置，因为它们的相对错位更大。
