【摘要】：目的評(píng)估二維數(shù)字減影血管造影(2D-DSA)及三維數(shù)字減影血管造影(3D-DSA)對(duì)顱內(nèi)動(dòng)脈瘤介入栓塞術(shù)中診斷及治療上的成像差異,評(píng)價(jià)2D-DSA及3D-DSA二種方法對(duì)顱內(nèi)動(dòng)脈瘤的診療價(jià)值,為臨床工作提供指導(dǎo)。方法回顧性分析242例動(dòng)脈瘤介入栓塞術(shù)病人,使用西門子公司的腦血管造影系統(tǒng),經(jīng)股動(dòng)脈行腦血管造影,對(duì)比劑使用碘普羅胺。2D-DSA常規(guī)拍攝雙側(cè)頸內(nèi)動(dòng)脈及至少一側(cè)椎動(dòng)脈的正位和側(cè)位像,必要時(shí)加入斜位像,造影劑注入速度為4ml/s。3D-DSA通過(guò)旋轉(zhuǎn)C臂180度,每秒采集6幀圖像,512*512矩陣。注藥流率:頸內(nèi)動(dòng)脈5ml/s,總量9ml,椎動(dòng)脈4ml/s,總量8ml。所采集圖像數(shù)據(jù)傳到workstation工作站進(jìn)行重建,后重建出3D-DSA圖像。重建方法采用容積再現(xiàn)顯示法。收集完整的2D-DSA及3D-DSA影像資料,比較兩種成像方法對(duì)動(dòng)脈瘤的檢出率、瘤頸與載瘤血管、穿通血管毗鄰關(guān)系,介入栓塞術(shù)后動(dòng)脈瘤瘤頸殘留情況。兩種方法的動(dòng)脈瘤檢出率比較,采用四格表χ2檢驗(yàn),動(dòng)脈瘤頸與載瘤動(dòng)脈關(guān)系比較,使用行乘列χ2檢驗(yàn),檢驗(yàn)結(jié)果均應(yīng)用SPSS 17.0軟件進(jìn)行統(tǒng)計(jì)評(píng)價(jià),P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果2D-DSA及3D-DSA兩種檢測(cè)方法,在動(dòng)脈瘤的檢出率(86.4%VS 100%),瘤頸與載瘤血管、穿通血管毗鄰關(guān)系的顯示(38.4%VS 90.1%,0 VS 10.7%),術(shù)后瘤頸殘留評(píng)估(0.4%VS7.8%),3D-DSA效果明顯優(yōu)于2D-DSA(P0.05)。結(jié)論3D-DSA在動(dòng)脈瘤檢出率、對(duì)術(shù)前情況分析和術(shù)后效果評(píng)估優(yōu)于2D-DSA,因此3D-DSA可作為動(dòng)脈瘤診療的“金標(biāo)準(zhǔn)”。
[Abstract]:Objective to evaluate the difference between two-dimensional digital subtraction angiography (2D-DSA) and three-dimensional digital subtraction angiography (3D-DSA) in the diagnosis and treatment of intracranial aneurysms during interventional embolization. To evaluate the value of 2D-DSA and 3D-DSA in the diagnosis and treatment of intracranial aneurysms and to provide guidance for clinical work. Methods A retrospective analysis of 242 patients undergoing interventional embolization of aneurysms was performed by using Siemens cerebral angiography system and femoral artery angiography. Contrast media were used with iodopropylamine. 2D-DSA routinely took positive and lateral images of the bilateral internal carotid artery and at least one side of the vertebral artery, adding oblique images if necessary. The injection rate of the contrast medium was 180 degrees through the rotation of the C arm of the 4ml/s.3D-DSA. Capture 6 frames of images per second, 512 x 512 matrix. Injection rate: internal carotid artery (5 ml / ml), total volume (9 ml), vertebral artery (4 ml / ml), total amount (8 ml / ml). The collected image data was transmitted to workstation for reconstruction, and then the 3D-DSA image was reconstructed. The reconstruction method was volume reproduction display method. The complete 2D-DSA and 3D-DSA images were collected to compare the detection rate of aneurysms, the adjacent relationship between the neck and the bearing vessels and perforating vessels, and the residual status of the aneurysm neck after interventional embolization. The detection rate of aneurysms in the two methods was compared. Four tabular 蠂 2 test was used to compare the relationship between the aneurysm neck and the bearing artery, and the multiplicative 蠂 2 test was used. The results of the test were statistically evaluated by SPSS 17.0 software. P0.05 was statistically significant. Results the detection rate of 2D-DSA and 3D-DSA was 100% in aneurysm (86.4%VS 100%), and the adjacent relationship between the neck of aneurysm and the bearing vessel and perforating vessel was shown (38.4%VS 90.1%, 0 VS 10.7%). Postoperative evaluation of tumor neck residue (0.4% vs 7.8%) showed that 3D-DSA was better than 2D-DSA (P0.05). Conclusion 3D-DSA is superior to 2D DSA in the detection rate, preoperative analysis and postoperative evaluation of aneurysms. Therefore, 3D-DSA can be used as the "gold standard" for the diagnosis and treatment of aneurysms.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743

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