■本研究的目的是评估选择性动脉内锥形束计算机断层扫描血管造影(CBCTA)相对于常规计算机断层扫描血管造影(CTA)在了解内脏动脉瘤(VAA)形态方面的价值,及其对治疗计划的影响。
■在2017年1月至2021年8月之间,对所有诊断为VAA并接受术中CBCTA成像的患者进行了回顾性分析。对治疗决定的影响,从CBCTA得出的最佳C臂角度,并报告了额外的辐射暴露。两名盲目的独立审阅者定性地审阅了CBCTA和常规CTA图像。5点李克特量表(1=图像质量差,5=出色的图像质量)用于评估每种模态的整体图像质量。对动脉瘤囊产生的血管数进行计数。
■在研究期间共有16名患者被诊断为VAA,其中10例患者进行了术中CBCTA和常规CTA检查。在10个病人中,7人接受了成功的血管内治疗,根据术中CBCTA结果,2例被认为不适合血管内栓塞,1例假性动脉瘤消退。所有手术的总透视时间和辐射剂量(剂量面积乘积[DAP]和皮肤剂量)为27.7±19.9分钟,28362(±18651)µGy*m2和1879(±1734)mGy,分别。来自CBCTA的辐射暴露(DAP和皮肤剂量)为5703(±3967)µGy*m2和223.6(±141.3)mGy,分别。在接受血管内治疗的患者中,CBCTA的比例DAP占手术总放射剂量的18.3%(±15.3%).CBCTA图像总体图像质量的定性评分优于CTA图像(平均得分为:4.55vs3,p<0.001)。与常规CTA相比,CBCTA中的所有审阅者都确定了更多由VAA引起的分支血管(中位数,最小值-最大值:3,0-4对2,1-3个血管)。
■选择性动脉内对比剂注射后的术中CBCTA,具有更好的空间分辨率,与常规相比,提供了更好的内脏动脉瘤形态勾画,静脉CTA,并在合理的额外辐射暴露下实现最佳治疗计划。
结论:内脏动脉瘤(VAA)通常是通过常规计算机断层扫描血管造影(CTA)来诊断的。血管内治疗通常需要在多个投影处进行选择性血管造影,以更好地了解动脉瘤形态。location,和传出分支血管。动脉内锥形束CT血管造影(CBCTA)用于VAA具有选择性对比剂混浊的优点,更好的空间分辨率,和动脉瘤形态的三维/多平面可视化。此外,CBCTA能够识别用于后续血管内治疗的最佳C臂工作投影。这项研究的目的是评估术中CBCTA相对于常规CTA在了解内脏动脉瘤形态及其对治疗计划的影响方面的价值。
The aim of this study is to evaluate the value of selective intra-arterial cone-beam computed tomography angiography (CBCTA) relative to conventional computed tomography angiography (CTA) in understanding visceral artery aneurysm (VAA) morphology, and its impact on treatment planning.
Between January 2017 and August 2021, all patients who had a diagnosis of VAA and underwent intraoperative CBCTA imaging were retrospectively reviewed. Impact on treatment decisions, optimal C-arm angulations derived from CBCTA, and additional radiation exposure were reported. Two blinded independent reviewers qualitatively reviewed CBCTA and conventional CTA images. A 5-point Likert scale (1=poor image quality, 5=excellent image quality) was used to assess the overall image quality of each modality. Number of vessels arising from the aneurysm sac was counted.
A total of 16 patients had a diagnosis of VAA during the study period, of whom 10 patients had intraoperative CBCTA and conventional CTA available for review. Out of 10 patients, 7 underwent successful endovascular treatment, 2 were deemed not amenable for endovascular embolization based on intraoperative CBCTA findings, and 1 had resolved pseudoaneurysm. Total fluoroscopy time and radiation dose (dose area product [DAP] and skin dose) for all procedures were 27.7 ± 19.9 minutes, 28 362 (±18 651) µGy*m2, and 1879 (±1734) mGy, respectively. Radiation exposure from CBCTA (DAP and skin dose) was 5703 (±3967) µGy*m2 and 223.6 (±141.3) mGy, respectively. In patients who underwent endovascular treatment, the proportional DAP from CBCTA was 18.3% (±15.3%) of the total procedural radiation dose. Qualitative rating of overall image quality of CBCTA images was superior to CTA images (mean score: 4.55 vs 3, p<0.001). More branch vessels arising from the VAA were identified by all reviewers in CBCTA as compared with conventional CTA (median, min-max: 3, 0-4 vs 2,1-3 vessels).
Intraoperative CBCTA after selective intra-arterial contrast injection, with better spatial resolution, provided better delineation of visceral aneurysm morphology as compared with conventional, intravenous CTA and enabled optimal treatment planning at a reasonable additional radiation exposure.
Visceral artery aneurysms (VAA) are often diagnosed incidentally by conventional computed tomographic angiography (CTA). Endovascular treatment typically requires selective angiographies at multiple projections to better understand aneurysm morphology, location, and efferent branch vessels. Intra-arterial cone-beam CT angiography (CBCTA) for VAA has the advantage of selective contrast opacification, better spatial resolution, and three-dimensional/multi-planar visualization of aneurysm morphology. In addition, CBCTA enables identification of optimal C-arm working projection for subsequent endovascular treatment. The aim of this study is to evaluate the value of intraoperative CBCTA relative to conventional CTA in understanding visceral artery aneurysm morphology and its impact on treatment planning.