“雙容積成像”對(duì)顱內(nèi)動(dòng)脈瘤即刻栓塞效果評(píng)價(jià)的研究
發(fā)布時(shí)間：2018-09-13 21:49
【摘要】：研究背景 顱內(nèi)動(dòng)脈瘤是顱內(nèi)動(dòng)脈管壁的異常膨出,是蛛網(wǎng)膜下腔出血(subarachnoid hemorrhage, SAH)的首位病因,在腦血管疾病病因中位居第3位,其死亡率和致殘率約占腦血管病死亡患者的22%-25%,并呈現(xiàn)逐漸遞增的趨勢(shì)。顱內(nèi)動(dòng)脈瘤首次破裂出血的死亡率約為15%-20%,未及時(shí)治療2年內(nèi)的死亡率達(dá)75%-85%,50%以上的破裂動(dòng)脈瘤存活者遺留不同程度的功能障礙。未破裂的動(dòng)脈瘤患者常無(wú)明顯不適,部分患者由于動(dòng)脈瘤的占位效應(yīng),可以出現(xiàn)顱腦神經(jīng)麻痹等局灶性癥狀。 近年來(lái)隨著介入材料和血管內(nèi)治療技術(shù)的不斷發(fā)展,血管內(nèi)治療已逐漸成為顱內(nèi)動(dòng)脈瘤的首選治療方法。血管內(nèi)介入治療以其微創(chuàng)的優(yōu)點(diǎn),也迅速被廣大臨床醫(yī)師及顱內(nèi)動(dòng)脈瘤患者所接受。隨著影像設(shè)備、微導(dǎo)管、微導(dǎo)絲和彈簧圈的性能改進(jìn)以及血管內(nèi)治療技術(shù)的普遍提高,血管內(nèi)治療的安全性也獲得顯著提高。然而,顱內(nèi)動(dòng)脈瘤的血管內(nèi)介入治療作為一種微創(chuàng)技術(shù),其手術(shù)風(fēng)險(xiǎn)仍然是無(wú)法避免的,總的并發(fā)癥發(fā)生率可達(dá)到8%-10%,部分病人甚至出現(xiàn)永久性致殘,甚至導(dǎo)致死亡。 據(jù)文獻(xiàn)報(bào)道動(dòng)脈瘤血管內(nèi)治療術(shù)后仍有較高的再通率,研究結(jié)果也顯示動(dòng)脈瘤的再通與動(dòng)脈瘤的栓塞程度密切相關(guān),栓塞程度越高復(fù)發(fā)的機(jī)會(huì)越少。因此要提高動(dòng)脈瘤的長(zhǎng)期療效,就必須提高動(dòng)脈瘤的栓塞程度,盡可能做到致密栓塞。目前對(duì)動(dòng)脈瘤血管內(nèi)治療術(shù)后栓塞結(jié)果較多采用的方法,即在動(dòng)脈瘤血管內(nèi)治療結(jié)束后進(jìn)行造影,根據(jù)動(dòng)脈瘤是否顯影及顯影的程度來(lái)判斷。通常采用：①文字描述：完全栓塞、“狗耳”樣殘留、頸殘留、體部殘留。②栓塞百分率表達(dá)：100%、99%～90%、90%或100%、99%～95%、95%；③將①和②兩種方式結(jié)合。采用這些半定量方法評(píng)價(jià)栓塞效果時(shí),不同的評(píng)判者可能會(huì)得出不同的結(jié)論,因此不能作為動(dòng)脈瘤血管內(nèi)治療的客觀的評(píng)價(jià)指標(biāo)。填塞率為血管內(nèi)治療置入彈簧圈體積與動(dòng)脈瘤體積比值,其作為一種作為動(dòng)脈瘤栓塞效果評(píng)價(jià)的定量指標(biāo),逐漸成為研究的熱點(diǎn)。如何對(duì)動(dòng)脈瘤栓塞術(shù)后即刻栓塞效果進(jìn)行準(zhǔn)確的評(píng)價(jià)是十分必要的。 目的：顱內(nèi)動(dòng)脈瘤即刻栓塞程度與動(dòng)脈瘤術(shù)后再通有密切關(guān)系,致密栓塞可顯著減少術(shù)后復(fù)發(fā),本研究的目的是研究雙容積成像對(duì)顱內(nèi)動(dòng)脈瘤即刻栓塞效果的評(píng)價(jià)價(jià)值,并分析影響顱內(nèi)動(dòng)脈瘤即刻栓塞結(jié)果的相關(guān)因素,為臨床治療提供理論依據(jù)和指導(dǎo)。 方法：收集2013年1月-2013年6月廣州軍區(qū)武漢總醫(yī)院神經(jīng)外科收治的經(jīng)血管內(nèi)介入治療的顱內(nèi)囊性動(dòng)脈瘤43例患者資料,每個(gè)動(dòng)脈瘤作為一個(gè)獨(dú)立的個(gè)體來(lái)研究,共43枚動(dòng)脈瘤。采集的數(shù)據(jù)包括：患者的性別、年齡、Hunt-Hess分級(jí)、動(dòng)脈瘤的大小、部位、瘤頸大小、動(dòng)脈瘤體積、治療方法、彈簧圈的體積、動(dòng)脈瘤的栓塞程度(致密栓塞和非致密栓塞)等。對(duì)術(shù)后即刻的二維DSA造影(2D-DSA)和雙容積成像進(jìn)行分析,比較2種成像技術(shù)顯示動(dòng)脈瘤殘留的能力。根據(jù)Raymond分級(jí)分為三類(lèi)：①完全栓塞：動(dòng)脈瘤瘤體及瘤頸均無(wú)造影劑充盈顯影；②瘤頸殘留：動(dòng)脈瘤瘤頸有造影劑充盈顯影而瘤體無(wú)造影劑充盈顯影；③動(dòng)脈瘤體殘留：動(dòng)脈瘤瘤體有造影劑充盈顯影,被認(rèn)為是動(dòng)脈瘤栓塞失敗。對(duì)以上數(shù)據(jù)采用多因素Spearman分析方法,分析影響動(dòng)脈瘤即刻栓塞結(jié)果的相關(guān)因素。所有統(tǒng)計(jì)資料用SPSS13.0統(tǒng)計(jì)分析系統(tǒng)進(jìn)行分析。當(dāng)P0.05時(shí)差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果：共43例患者,其中女性25例,男性18例�；颊咂骄挲g在56歲。36例為破裂動(dòng)脈瘤,7例為未破裂動(dòng)脈瘤。25例行支架輔助彈簧圈栓塞術(shù),18例行單純彈簧圈栓塞術(shù),其中9例行雙微導(dǎo)管栓塞。后交通動(dòng)脈瘤19例,前交通動(dòng)脈瘤10例,大腦中動(dòng)脈瘤7例,眼動(dòng)脈動(dòng)脈瘤3例,床突上段動(dòng)脈瘤3例,大腦前動(dòng)脈A1段動(dòng)脈瘤1例。動(dòng)脈瘤小于5mm：20例,5mm至10mm：19例,大于10mm:4例。動(dòng)脈瘤的體積從7.3mm3到2498mm3,平均190.15mm3,動(dòng)脈瘤的體積小于50mm3：13例,50mm3到100mm3：10例,大于100mm320例。瘤頸大小從1.58mm到9.16mm,平均4.29mm,頸體比從1.01至2.56,平均1.39。根據(jù)頸體比分為三組：小于1.5mm：32例,1.5mm到2mm：8例,大于2mm：3例,動(dòng)脈瘤的填塞率從4%-38%,平均為18.25%,小于10%：4例,10%-15%：9例,15%-20%：16例,大于20%：14例。術(shù)后即刻2D-DSA完全栓塞26例(60.5%),瘤頸殘留10例(23.3%),瘤體殘留7例(16.3%),術(shù)后即刻雙容積成像發(fā)現(xiàn)完全栓塞16例(37.2%),瘤頸殘留16例(37.2%),瘤體殘留11例(25.6%)。2組間比較差異有統(tǒng)計(jì)學(xué)意義(Z=-2.009, P=0.045)。2D-DSA評(píng)價(jià)為完全栓塞組的填塞率為0.20±0.07,2D-DSA評(píng)價(jià)為非完全栓塞組填塞率為0.16±0.04,雖然完全栓塞組填塞率大于動(dòng)脈瘤殘留組的填塞率,但二者差異尚不具有統(tǒng)計(jì)學(xué)意義(t=1.918,P=0.0620.05)。雙容積成像評(píng)價(jià)為完全栓塞組的填塞率為0.22±0.06,雙容積成像評(píng)價(jià)為非完全栓塞組的填塞率為0.16±0.05,雙容積成像完全栓塞組的填塞率顯著高于非完全栓塞組的填塞率,差異有統(tǒng)計(jì)學(xué)意義(t=3.037P0.05)。多因素Spearman分析顯示動(dòng)脈瘤大小(r-0.353p=0.020)、動(dòng)脈瘤體積(r-0.449p=0.003)是顱內(nèi)動(dòng)脈瘤致密栓塞的影響因素。 結(jié)論：雙容積成像能夠提高動(dòng)脈瘤即刻栓塞殘留的檢出率。雙容積評(píng)價(jià)為致密栓塞的顱內(nèi)動(dòng)脈瘤其填塞率高。顱內(nèi)動(dòng)脈瘤的大小及動(dòng)脈瘤的體積大小是影響動(dòng)脈瘤填塞率的影響因素,且均為負(fù)相關(guān),即動(dòng)脈瘤越大、容積越大,填塞率越低。
[Abstract]:Research background
Intracranial aneurysms are the abnormal bulge of intracranial arterial wall, and the first cause of subarachnoid hemorrhage (SAH). They are the third cause of cerebrovascular diseases. The mortality and disability rate of SAH patients are about 22% - 25% of the total death rate of cerebrovascular diseases. The mortality of first rupture of intracranial aneurysms and hemorrhage is increasing gradually. The mortality rate is about 15%-20%. The mortality rate is 75%-85% in 2 years without prompt treatment. More than 50% of the survivors of ruptured aneurysms have left varying degrees of dysfunction.
In recent years, with the continuous development of interventional materials and endovascular treatment technology, endovascular treatment has gradually become the preferred treatment of intracranial aneurysms. With its advantages of minimally invasive, endovascular treatment has also been rapidly accepted by clinicians and patients with intracranial aneurysms. With the development of imaging equipment, microcatheters, microwire and coils However, as a minimally invasive technique, intravascular interventional therapy for intracranial aneurysms is still unavoidable. The overall incidence of complications can reach 8% - 10%. Some patients even suffer from permanent disability or even permanent disability. Cause death.
It is reported that the recanalization rate of aneurysms is still high after endovascular treatment. The results also show that the recanalization of aneurysms is closely related to the degree of embolization, and the higher the degree of embolization, the less the chance of recurrence. At present, embolization results after endovascular treatment of aneurysms are often used, that is, after endovascular treatment of aneurysms, angiography, according to whether the aneurysm is developed and the degree of development to judge. Usually used: 1. Written description: complete embolization, "dog ear" like residue, neck residue, body residue. 2 Embolization percentage expression: 1. 00%, 99% ~ 90%, 90% or 100%, 99% ~ 95%, 95%; 3) Combine the two methods. When using these semi-quantitative methods to evaluate the embolization effect, different judges may come to different conclusions, so they can not be used as an objective evaluation index for endovascular treatment of aneurysms. As a quantitative index for evaluating the embolization effect of aneurysms, tumor volume ratio has gradually become a research hotspot.
Objective: Immediate embolization of intracranial aneurysms is closely related to the recanalization of aneurysms. Compact embolization can significantly reduce postoperative recurrence. The purpose of this study is to study the value of dual-volume imaging in evaluating the effect of immediate embolization of intracranial aneurysms, and to analyze the related factors affecting the results of immediate embolization of intracranial aneurysms, so as to provide clinical treatment. For theoretical basis and guidance.
METHODS: The data of 43 patients with intracranial cystic aneurysms treated by endovascular interventional therapy in the Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Region from January 2013 to June 2013 were collected. Each aneurysm was studied as an independent individual with 43 aneurysms. The size, location, neck size, aneurysm volume, treatment method, coil volume, embolization degree of aneurysm (dense embolism and non-dense embolism) were analyzed. The two imaging techniques, two-dimensional DSA (two-dimensional DSA) and two-volume imaging (two-dimensional DSA) were compared to show the residual aneurysm ability. Complete embolization: Neither aneurysm nor neck had contrast agent filling imaging; Neck residue: Neck of aneurysm had contrast agent filling imaging but no contrast agent filling imaging; Neck of aneurysm residue: Neck of aneurysm had contrast agent filling imaging; Neck of aneurysm residue: Neck of aneurysm had contrast agent filling imaging, which was considered aneurysm embolization failure. All statistical data were analyzed by SPSS13.0 statistical analysis system. The difference was statistically significant when P 0.05.
Results: A total of 43 patients, including 25 females and 18 males, had an average age of 56.36 with ruptured aneurysms, 7 with unruptured aneurysms, 25 with stent-assisted coil embolization, 18 with simple coil embolization, 9 with dual-microcatheter embolization, 19 with posterior communicating aneurysms, 10 with anterior communicating aneurysms, and 7 with middle cerebral artery. There were 7 aneurysms, 3 ophthalmic aneurysms, 3 superior clinoid aneurysms, 1 anterior cerebral artery A1 aneurysm, 19 aneurysms less than 5 mm: 20, 5 mm to 10 mm: 19, more than 10 mm: 4. The aneurysms ranged in size from 7.3 mm3 to 2498 mm3, with an average of 190.15 mm3, the aneurysms less than 50 mm3 to 100 mm3: 13, 50 mm3 to 100 mm3: 10, and more than 100 mm320 aneurysms. From 1.58 mm to 9.16 mm, average 4.29 mm, neck-body ratio from 1.01 to 2.56, average 1.39. According to neck-body ratio, they were divided into three groups: less than 1.5 mm: 32 cases, 1.5 mm to 2 mm: 8 cases, more than 2 mm: 3 cases, aneurysm tamponade rate from 4% to 38%, average 18.25%, less than 10% - 15%: 9 cases, 15% - 20%: 16 cases, more than 20%: 14 cases. There were 16 cases (37.2%) with complete embolization, 16 cases (37.2%) with residual tumor neck and 11 cases (25.6%) with residual tumor neck. There were significant differences between the two groups (Z = - 2.009, P = 0.045). The packing rate of complete embolization group was 0.20 [0.07], and non-embolization group was evaluated by 2D-DSA. The filling rate of complete embolization group was 0.16 [0.04]. Although the filling rate of complete embolization group was higher than that of residual aneurysm group, there was no significant difference between the two groups (t = 1.918, P = 0.0620.05). The filling rate of complete embolization group was 0.22 [0.06], and that of incomplete embolization group was 0.16 [0.05] by dual volume imaging. The filling rate of complete embolization group was significantly higher than that of incomplete embolization group (t = 3.037 P 0.05). Multivariate Spearman analysis showed that the size of aneurysm (r-0.353 P = 0.020) and the volume of aneurysm (r-0.449 P = 0.003) were the influencing factors of intracranial aneurysm compact embolization.
Conclusion: Dual-volume imaging can improve the detection rate of aneurysm embolization residual immediately. Dual-volume evaluation of dense embolization of intracranial aneurysms has a high rate of tamponade. Low.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R739.41
本文編號(hào)：2241840
[Abstract]:Research background
Intracranial aneurysms are the abnormal bulge of intracranial arterial wall, and the first cause of subarachnoid hemorrhage (SAH). They are the third cause of cerebrovascular diseases. The mortality and disability rate of SAH patients are about 22% - 25% of the total death rate of cerebrovascular diseases. The mortality of first rupture of intracranial aneurysms and hemorrhage is increasing gradually. The mortality rate is about 15%-20%. The mortality rate is 75%-85% in 2 years without prompt treatment. More than 50% of the survivors of ruptured aneurysms have left varying degrees of dysfunction.
In recent years, with the continuous development of interventional materials and endovascular treatment technology, endovascular treatment has gradually become the preferred treatment of intracranial aneurysms. With its advantages of minimally invasive, endovascular treatment has also been rapidly accepted by clinicians and patients with intracranial aneurysms. With the development of imaging equipment, microcatheters, microwire and coils However, as a minimally invasive technique, intravascular interventional therapy for intracranial aneurysms is still unavoidable. The overall incidence of complications can reach 8% - 10%. Some patients even suffer from permanent disability or even permanent disability. Cause death.
It is reported that the recanalization rate of aneurysms is still high after endovascular treatment. The results also show that the recanalization of aneurysms is closely related to the degree of embolization, and the higher the degree of embolization, the less the chance of recurrence. At present, embolization results after endovascular treatment of aneurysms are often used, that is, after endovascular treatment of aneurysms, angiography, according to whether the aneurysm is developed and the degree of development to judge. Usually used: 1. Written description: complete embolization, "dog ear" like residue, neck residue, body residue. 2 Embolization percentage expression: 1. 00%, 99% ~ 90%, 90% or 100%, 99% ~ 95%, 95%; 3) Combine the two methods. When using these semi-quantitative methods to evaluate the embolization effect, different judges may come to different conclusions, so they can not be used as an objective evaluation index for endovascular treatment of aneurysms. As a quantitative index for evaluating the embolization effect of aneurysms, tumor volume ratio has gradually become a research hotspot.
Objective: Immediate embolization of intracranial aneurysms is closely related to the recanalization of aneurysms. Compact embolization can significantly reduce postoperative recurrence. The purpose of this study is to study the value of dual-volume imaging in evaluating the effect of immediate embolization of intracranial aneurysms, and to analyze the related factors affecting the results of immediate embolization of intracranial aneurysms, so as to provide clinical treatment. For theoretical basis and guidance.
METHODS: The data of 43 patients with intracranial cystic aneurysms treated by endovascular interventional therapy in the Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Region from January 2013 to June 2013 were collected. Each aneurysm was studied as an independent individual with 43 aneurysms. The size, location, neck size, aneurysm volume, treatment method, coil volume, embolization degree of aneurysm (dense embolism and non-dense embolism) were analyzed. The two imaging techniques, two-dimensional DSA (two-dimensional DSA) and two-volume imaging (two-dimensional DSA) were compared to show the residual aneurysm ability. Complete embolization: Neither aneurysm nor neck had contrast agent filling imaging; Neck residue: Neck of aneurysm had contrast agent filling imaging but no contrast agent filling imaging; Neck of aneurysm residue: Neck of aneurysm had contrast agent filling imaging; Neck of aneurysm residue: Neck of aneurysm had contrast agent filling imaging, which was considered aneurysm embolization failure. All statistical data were analyzed by SPSS13.0 statistical analysis system. The difference was statistically significant when P 0.05.
Results: A total of 43 patients, including 25 females and 18 males, had an average age of 56.36 with ruptured aneurysms, 7 with unruptured aneurysms, 25 with stent-assisted coil embolization, 18 with simple coil embolization, 9 with dual-microcatheter embolization, 19 with posterior communicating aneurysms, 10 with anterior communicating aneurysms, and 7 with middle cerebral artery. There were 7 aneurysms, 3 ophthalmic aneurysms, 3 superior clinoid aneurysms, 1 anterior cerebral artery A1 aneurysm, 19 aneurysms less than 5 mm: 20, 5 mm to 10 mm: 19, more than 10 mm: 4. The aneurysms ranged in size from 7.3 mm3 to 2498 mm3, with an average of 190.15 mm3, the aneurysms less than 50 mm3 to 100 mm3: 13, 50 mm3 to 100 mm3: 10, and more than 100 mm320 aneurysms. From 1.58 mm to 9.16 mm, average 4.29 mm, neck-body ratio from 1.01 to 2.56, average 1.39. According to neck-body ratio, they were divided into three groups: less than 1.5 mm: 32 cases, 1.5 mm to 2 mm: 8 cases, more than 2 mm: 3 cases, aneurysm tamponade rate from 4% to 38%, average 18.25%, less than 10% - 15%: 9 cases, 15% - 20%: 16 cases, more than 20%: 14 cases. There were 16 cases (37.2%) with complete embolization, 16 cases (37.2%) with residual tumor neck and 11 cases (25.6%) with residual tumor neck. There were significant differences between the two groups (Z = - 2.009, P = 0.045). The packing rate of complete embolization group was 0.20 [0.07], and non-embolization group was evaluated by 2D-DSA. The filling rate of complete embolization group was 0.16 [0.04]. Although the filling rate of complete embolization group was higher than that of residual aneurysm group, there was no significant difference between the two groups (t = 1.918, P = 0.0620.05). The filling rate of complete embolization group was 0.22 [0.06], and that of incomplete embolization group was 0.16 [0.05] by dual volume imaging. The filling rate of complete embolization group was significantly higher than that of incomplete embolization group (t = 3.037 P 0.05). Multivariate Spearman analysis showed that the size of aneurysm (r-0.353 P = 0.020) and the volume of aneurysm (r-0.449 P = 0.003) were the influencing factors of intracranial aneurysm compact embolization.
Conclusion: Dual-volume imaging can improve the detection rate of aneurysm embolization residual immediately. Dual-volume evaluation of dense embolization of intracranial aneurysms has a high rate of tamponade. Low.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R739.41
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