Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, Kanagawa, Japan; Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Department of Neurosurgery, Kuroda Neurosurgery Clinic, Sagamihara, Kanagawa, Japan.
Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, Kanagawa, Japan.
World Neurosurg. 2022 Nov;167:e1219-e1224. doi: 10.1016/j.wneu.2022.09.018. Epub 2022 Sep 8.
Preoperative identification of the carotid bifurcation (CB) location and plaque and stenosis distal end of the cervical internal carotid artery in relation to bony structures is essential for carotid endarterectomy (CEA). However, for patients with contrast contraindications, cervical 3-dimensional computed tomography angiography (3D-CTA) is unavailable. In this study, we created fusion images of magnetic resonance angiography (MRA), black-blood (BB) magnetic resonance imaging (MRI), and CT to determine if these noncontrast agent images are superior to 3D-CTA for preoperative CEA planning.
The fusion images showed vascular structures obtained by MRA, plaque observed by BB-MRI, and bone structures shown by CT. Spatial localization accuracy was verified by directly overlaying contrast-enhanced 3D-CTA images on the fusion images. We validated this technique in 50 patients with unilateral ICA stenosis, 28 of whom underwent CEA. The 2D-distance CB MRA-CTA (the 2D distance difference between CB MRA and CB CTA perpendicular to the long axis of the carotid artery) was measured. We also compared the findings of the fusion image regarding the CB location and plaque distal end with the operative findings.
The median 2D distance CB MRA-CTA was 1 mm. CB MRA was located distal and proximal to CB CTA in 21and 29 patients, respectively. The CB location and fusion-image plaque were consistent with the intraoperative findings in all CEA patients.
Fusion images created from MRA, BB-MRI, and noncontrast CT were feasible as an alternative to 3D-CTA for patients with contrast contraindications.
术前识别颈动脉分叉（CB）位置以及颈内动脉颅外段斑块和狭窄的远端与骨结构的关系对颈动脉内膜切除术（CEA）至关重要。然而，对于有造影剂禁忌的患者，无法进行颈椎 3 维计算机断层血管造影（3D-CTA）。在这项研究中，我们创建了磁共振血管造影（MRA）、黑血（BB）磁共振成像（MRI）和 CT 的融合图像，以确定这些非造影剂图像是否优于 3D-CTA 用于 CEA 术前规划。
融合图像显示了 MRA 获得的血管结构、BB-MRI 观察到的斑块以及 CT 显示的骨结构。通过直接将增强 3D-CTA 图像叠加在融合图像上，验证了空间定位的准确性。我们在 50 例单侧 ICA 狭窄患者中验证了该技术，其中 28 例行 CEA。测量了 MRA-CTA 之间的 2D 距离（CB MRA 和 CB CTA 垂直于颈动脉长轴的 2D 距离差）。我们还比较了融合图像关于 CB 位置和斑块远端的结果与手术结果。
中位数 2D 距离 CB MRA-CTA 为 1mm。CB MRA 在 21 例患者中位于 CB CTA 的远端和近端，在 29 例患者中位于 CB CTA 的近端和远端。在所有接受 CEA 的患者中，CB 位置和融合图像上的斑块与术中发现一致。
MRA、BB-MRI 和非对比 CT 的融合图像可作为对比剂禁忌患者的 3D-CTA 替代方案。
