METHODS: This prospective study included 22 patients with unruptured IAs and 8 with ruptured IAs undergoing aneurysm clipping surgery (≥3 mm). TOF-MRA and CT/3D-CTA scans were fused using 3D Slicer. Neuroradiologists and neurosurgeons independently assessed 3D-CTA and synthetic TOF-MRA-CT images for aneurysm detection rates, morphology, and dimensions. Evaluation metrics included dice similarity coefficient and 95% Hausdorff distance.
RESULTS: Evaluation of aneurysm detection rates, morphology, and dimensions showed no significant differences between synthetic TOF-MRA-CT fusion images and 3D-CTA (all P > 0.05). Neuroradiologist assessments revealed strong concordance in aneurysm morphology between synthetic TOF-MRA-CT fusion images and 3D-CTA (κ = 0.867, P < 0.001). The dice similarity coefficient (0.937 ± 0.012) and Hausdorff distance (4.54 ± 0.26) indicated a high degree of image overlap between synthetic TOF-MRA-CT fusion images and 3D-CTA. Surgeons rated the consistency of aneurysm morphology between synthetic TOF-MRA-CT fusion images and intraoperative findings as strongly concordant (κ = 0.873, P < 0.001).
CONCLUSIONS: Synthetic TOF-MRA-CT fusion images closely match 3D-CTA for ≥3 mm aneurysms, demonstrating comparable diagnostic and surgical clipping planning effectiveness. They represent a promising alternative for personalized preoperative planning, particularly when contrast agents are contraindicated.
方法:这项前瞻性研究包括22例接受动脉瘤夹闭手术(≥3mm)的未破裂IAs(UIA)和8例破裂IAs(RIA)患者。使用3DSlicer融合TOF-MRA和CT/3D-CTA扫描。神经放射科医生和神经外科医生独立评估3D-CTA和合成TOF-MRA-CT图像的动脉瘤检出率,形态学,和尺寸。评估指标包括骰子相似系数(DSC)和95%Hausdorff距离(HD)。
结果:动脉瘤检出率的评估,形态学,合成TOF-MRA-CT融合图像与3D-CTA的尺寸差异均无统计学意义(均p>0.05)。神经放射学家的评估显示,合成TOF-MRA-CT融合图像与3D-CTA之间的动脉瘤形态具有很强的一致性(κ=0.867,p<0.001)。DSC(0.937±0.012)和HD(4.54±0.26)表明合成TOF-MRA-CT融合图像与3D-CTA之间存在高度图像重叠。外科医生将合成TOF-MRA-CT融合图像与术中发现之间的动脉瘤形态一致性评价为高度一致(κ=0.873,p<0.001)。
结论:合成TOF-MRA-CT融合图像与≥3mm动脉瘤的3D-CTA紧密匹配,证明具有可比性的诊断和手术夹闭计划的有效性。它们代表了个性化术前计划的有希望的替代方案,特别是当造影剂是禁忌的。