【摘要】 目的探讨三维DSA与头部MRI、CT融合技术指导颅内动静脉畸形(AVM)个体化治疗的应用价值。方法回顾性分析南京军区南京总医院神经外科2015年1月至5月经DSA诊断明确为AVM的21例患者,术前分别行DSA、MRI或CT检查,并行三维DSA与MRI或CT融合。在21例患者中,对15例行MRI与三维DSA融合,对6例行CT与三维DSA融合。结合患者影像融合结果进一步制订个体化治疗方案,治疗方案包括显微外科切除、血管内栓塞、立体定向放射(单一或综合)治疗。术后对患者进行2~6个月的随访观察。结果从患者术前三维DSA与头部MRI、CT融合图像,不仅可清晰地观察AVM的血管构筑、畸形团与周围神经结构之间的毗邻关系,同时对合并小动脉瘤的AVM或微小AVM可精准定位血管病变在脑组织的位置。结合影像融合结果,对17例患者行AVM显微外科切除术,2例患者行介入栓塞联合立体定向放射治疗,2例患者行立体定向放射治疗。17例行显微外科切除的AVM患者,随访期间无一例发生颅内再出血,末次格拉斯哥预后量表(GOS)评分5分者13例,4分者4例;1例行联合立体定向放射治疗的AVM患者在随访期间发生颅内再出血,末次GOS评分4分;其余3例患者随访期间未有新发神经功能缺损或再出血,GOS评分5分。结论三维DSA与头部MRI、CT融合技术新颖,操作方法简便,融合图像精准,能够有效地辅助制订AVM患者个体化治疗方案。更多还原

【Abstract】 Objective To investigate the applicative value of 3D-DSA and head MRI or CT fusion technology for guiding the individualized treatment of intracranial arteriovenous malformation( AVM).Methods Twenty-one patients with AVM diagnosed with DSA at the Department of Neurosurgery,Nanjing General Hospital of Nanjing Military Command from January 2015 to May 2015 were analyzed retrospectively.All patients performed DSA,MRI,and CT scan respectively before procedure,and they also performed3 D-DSA and MRI or CT fusion. Of the 21 patients,15 performed MRI and 3D-DSA fusion,6 performed CT and 3D-DSA fusion. According to the image fusion results of the patients,the individualized treatment regimens were further developed,including microsurgical resection,endovascular embolization,and stereotactic radiotherapy( alone or combined treatment). The patients were followed up and observed for 2 to 6 months after procedure. Results From the 3D-DSA with head MRI or CT fusion images of the patients before the procedure not only could observe the vascular architecture of AVM,the relationship between the niduses and the surrounding nerve structures,but also could precisely locate the positions of AVM with small aneurysms or tiny AVMs. According to the results of image fusion,17 patients with AVM were treated with microsurgical resection,2 were treated with interventional embolization and stereotactic radiotherapy,and 2 were treated with stereotactic radiotherapy only. Of the 17 patients with AVM underwent microsurgical resection,none experienced intracranial rebleeding during the follow-up period. The last Glasgow outcome scale( GOS) score was 5 in 13 cases,and 4 in 4 cases. One patient with AVM underwent combined stereotactic radiotherapy had intracranial rebleeding during the follow-up period,and their last GOS score was 4. The other remaining 3 patients did not have new neurological deficits or rebleeding during the follow-up period,and their GOS score was 5. Conclusions 3 D-DSA,head M RI,and CT fusion technology are novel,the operative m ethod is sim ple,and the fusion im age is accurate. They can effectively develop the individualized treatm ent regim ens for patients with AVM.更多还原