目的:鉴于其高空间分辨率和脉管系统选择性,通过选择性3D旋转血管造影(3DRA)获得的锥形束计算机断层扫描(CT)血管造影(CBCTA)图像是最适合用于颅内动静脉畸形(AVM)和硬脑膜动静脉瘘(DAVFs)的立体定向放射外科(SRS)目标定义的3D图像.此外,基于3DRA的CBCTA相对较低的时间分辨率可以通过正交配对2D动态数字减影血管造影(2D-DSA)的立体定向配准来补充.2D-DSA的集成,通常限制在每个投影的一个或几个帧,只能在SRS当天通过专用图像定位器在颅骨的刚性框架固定下通过导管引导的血管造影来实现CBCTA和/或计划CT。这给患者带来了巨大的负担。这项研究旨在证明一个小说,方便,以及在商用专用软件上对双平面2D-DSA整帧和CBCTA进行无框架配准的侵入性显着较小的方法,即,Brainlab®Elements(BrainlabAG,慕尼黑,德国),并提出了图像融合成功的先决条件。技术报告:元素提供了以下功能:从包含血管细节的任何3D图像系列中自动提取3D脉管系统图像作为浮动图像,然后手动自动地与选定的2D-DSA帧对进行共同配准六自由度刚性配准。作为一项临床前可行性研究,使用来自患有脑AVM和横向乙状结肠(TS)DAVF的患者的两个匿名图像数据集来验证Elements用于2D/3D血管图像的无框配准的准确性和实用性,特别是关于SRS计划目标描绘的临床工作流程的假设。使用普通的未减量CBCTA导致对邻接血管或靠近骨结构的血管的提取不足。特别是在TS-DAVF的情况下,瘘管袋和受影响的静脉窦与颅骨相邻。相比之下,与减除CBCTA相比,血管的数量和选择性以及后续图像融合的准确性显著提高.将CBCTA集成到动态2D-DSA中允许通过在公共3D坐标下共享任何有关点和2D或3D结构来同时查看两个图像信息。
结论:元素使临床上有用的无框架双平面2D-DSA整个框架配准到CBCTA中,为此,用于普通诊断目的的减影和未减影CBCTA轴向图像的常规采集是成功的图像融合和进一步广泛应用的必不可少的先决条件。这种2D/3D血管造影的无框架集成将极大地增强基于框架和无框架的SRS工作流程和环境,允许用户在SRS之前提前转发SRS计划。随着SRS当天侵入性血管造影的遗漏,并将扩大无框架SRS的实施范围。此外,与单独查看每个图像相比,对2D/3D整合血管造影的全面交替交互式审查可更深入地了解受影响的血管结构。
OBJECTIVE: Given its high spatial resolution and vasculature selectivity, the cone-beam computed tomography (CT) angiography (CBCTA) image acquired by selective 3D rotational angiography (3DRA) is the most suitable 3D image for the target definition of stereotactic radiosurgery (SRS) for intracranial arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs). Furthermore, the relatively low temporal resolution of 3DRA-based CBCTA can be complemented by the stereotactic co-registration of orthogonally paired 2D dynamic digital subtraction angiography (2D-DSA). The integration of 2D-DSA, which is usually limited to one or a few frames for each projection, into CBCTA and/or planning CT can be achieved only by catheter-directed angiography on the day of SRS via a dedicated image localizer under rigid frame fixation to the skull, which imposes substantial burdens on patients. This study aimed to demonstrate a novel, convenient, and significantly less invasive method for the
frameless co-registration of biplane 2D-DSA whole frames and CBCTA on commercially available dedicated software, namely, Brainlab® Elements (Brainlab AG, Munich, Germany), and present its prerequisite for successful image fusion. Technical Report: Elements have afforded the following functionality: A 3D vasculature image is automatically extracted as a floating image from any 3D image series containing vascular details and then subsequently co-registered manually and automatically to a selected frame pair of 2D-DSA with a six-degree-of-freedom rigid registration. As a preclinical feasibility study, two anonymous image datasets from patients harboring cerebral AVM and transverse-sigmoid (TS) DAVF were used to verify the accuracy and practicality of Elements for the
frameless co-registration of 2D/3D vascular images, particularly on the assumption of clinical workflow for the target delineation of SRS planning. The use of ordinary unsubtracted CBCTA resulted in the insufficient extraction of abutting vessels or vessels that are in close proximity to bony structures, particularly in the case of TS-DAVF, where the fistulous pouch and the affected venous sinuses were adjacent to the cranial bone. By contrast, the amount and selectivity of vasculatures and the accuracy of subsequent image fusion were significantly improved from the subtracted CBCTA. The integration of CBCTA into dynamic 2D-DSA allowed the simultaneous review of both image information by sharing any concerning point and 2D or 3D structures under a common 3D coordinate.
CONCLUSIONS: Elements enable the clinically useful
frameless co-registration of biplane 2D-DSA whole frames into CBCTA, for which the routine acquisition of both subtracted and unsubtracted CBCTA axial images for ordinary diagnostic purposes is an indispensable prerequisite for successful image fusion and further widespread application. This
frameless integration of the 2D/3D angiogram would dramatically enhance both the frame-based and
frameless SRS workflow and circumstances by allowing users to forward SRS planning well in advance before SRS, along with the omission of invasive angiography on the day of SRS, and would broaden the implementation of frameless SRS. Furthermore, the comprehensive alternating interactive review of the 2D/3D integrated angiogram leads to a more in-depth quasi-4D understanding of the affected angioarchitectures compared with the separate viewing of each image.