DSA和MRI三维融合在前交通动脉瘤夹闭术前计划中的应用

doi:10.3969/j.issn.1672-6731.2020.04.014

摘要/Abstract

摘要：

目的探讨DSA与MRI三维融合重建技术要点及其在前交通动脉瘤夹闭术前制定手术计划和模拟手术过程中的应用价值。方法 2016年9月至2019年5月对30例未破裂前交通动脉瘤患者行开颅动脉瘤夹闭术，术前通过3D-Slicer软件融合MRI与DSA，重建脑组织、视神经和颈内动脉模型，制定手术计划并模拟手术过程。以术者术中判断作为"金标准"，计算三维融合重建模型评估直回切除，大脑前动脉A1段优势侧，血管与动脉瘤体粘连的敏感性、特异性、假阴性率、假阳性率。结果所有患者均于术前完成DSA与MRI的三维融合重建，该模型对直回切除、大脑前动脉A1段优势、该血管与动脉瘤体粘连评估的灵敏度为100%（23/23）、75%（21/28）和81.82%（18/22），特异度42.86%（3/7）、100%（2/2）和62.50%（5/8），假阴性率为0（0/23）、25%（7/28）和18.18%（4/22），假阳性率57.14%（4/7）、0（0/2）和37.50%（3/8）；三维融合重建模型与术者术中判断一致性（κ值）分别为0.535（P=0.001）、0.504（P=0.000）和0.426（P=0.010）。结论通过3D-Slicer软件实现DSA与MRI的三维融合重建是一项影像后处理技术，将脑组织、视神经、颈内动脉相融合，对前交通动脉瘤夹闭术前制定手术计划和训练青年医师手术思维具有较高的应用价值。

关键词: 颅内动脉瘤, 神经外科手术, 磁共振成像, 血管造影术, 数字减影

Abstract:

Objective To investigate the 3D fusion technique of DSA and MRI and its application value in making surgical plan and simulating operative process for anterior communicating artery (ACoA) aneurysm clipping. Methods From September 2016 to May 2019, aneurysm clipping was performed on 30 patients with unruptured ACoA aneurysm. Infusions of DSA and MRI before surgery with 3D-Slicer software were performed to reconstruct the brain tissue, optic nerve and internal carotid artery (ICA) model. Using 3D fusion model to make surgical plan and simulate operative process. Comparing 3D fusion model with golden standard, which refers to the surgeon's judgement during surgery, then calculated sensitivity, specificity, false negative rate and false positive rate of rectus gyrus resection, dominance of ACA A1 segment and artery adhesion to the aneurysm. Results 3D fusion of DSA and MRI in 30 patients with ACoA aneurysm were performed. Statistical analysis showed the sensitivity of rectus gyrus resection, the dominance of ACA A1 segment and artery adhesion to the aneurysm were 100% (23/23), 75% (21/28) and 81.82% (18/22), specificity were 42.86% (3/7), 100% (2/2) and 62.50% (5/8), false negative rate were 0 (0/23), 25% (7/28) and 18.18% (4/22), and false positive rate were 57.14% (4/7), 0 (0/2) and 37.50% (3/8). The consistency (κ value) were 0.535 (P=0.001), 0.504 (P=0.000) and 0.426 (P=0.010). Conclusions Using 3D-Slicer software to realize 3D fusion of DSA and MRI is an image post-processing technology, which integrates brain tissues, optic nerve and ICA, has a high application value for preoperative plan and surgical training of ACoA aneurysm clipping for younger surgeons.

Key words: Intracranial aneurysm, Neurosurgical procedures, Magnetic resonance imaging, Angiography, digital subtraction

赵悦, 薛哲, 攸娜, 刘羽阳, 武琛, 张军, 许百男. DSA和MRI三维融合在前交通动脉瘤夹闭术前计划中的应用[J]. 中国现代神经疾病杂志, 2020, 20(4): 338-346.

ZHAO Yue, XUE Zhe, YOU Na, LIU Yu-yang, WU Chen, ZHANG Jun, XU Bai-nan. The application of 3D fusion of DSA and MRI in anterior communicating artery aneurysm clipping[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(4): 338-346.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I4/338

参考文献

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The application of 3D fusion of DSA and MRI in anterior communicating artery aneurysm clipping

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The application of 3D fusion of DSA and MRI in anterior communicating artery aneurysm clipping

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