容积CT数字减影血管造影与匹配蒙片去骨法在颅内动脉瘤头颈CT血管成像减影效果的比较研究

Subtraction effect of volume CT digital subtraction angiography versus CT angiography with matched mask bone elimination of the head and neck in patients with intracranial aneurysm：a comparative study

摘要:

目的：比较容积CT数字减影血管造影（volume computed tomography digital subtraction angiography，VCTDSA）与匹配蒙片去骨法（matched mask bone elimination，MMBE）对颅内动脉瘤患者头颈CT血管成像（CT angiography，CTA）减影的图像质量。方法：回顾性分析2017年3月至2018年3月于我院行头颈CTA检查且诊断颅内动脉瘤的47名患者资料。分别使用GE AW4.6 后处理工作站VCTDSA减影技术与SIEMENS Syngovia后处理工作站MMBE减影技术对这47名患者头颈CTA的原始图像进行后处理，比较不同减影技术的自动减影时间、手动减影时间和总减影时间，并评价减影后的去骨情况，血管的减影效果及动脉瘤显示情况。结果：VCTDSA和MMBE的自动减影时间、手动减影时间和总减影时间分别为12、598、561.5 s和76、288、375 s，差异具有统计学意义（P<0.01）。VCTDSA在减影后颈内动脉颅内段和静脉窦的减影效果及动脉瘤显示情况均优于MMBE，而其减影后的去骨情况较MMBE差，差异均具有统计学意义（P<0.01）。对于颈内动脉虹吸部的动脉瘤，VCTDSA的显示情况优于MMBE，差异具有统计学意义（P<0.01）。结论：VCTDSA的自动去骨速度快、效果好，对头颈部血管、动脉瘤的显示优于MMBE，有助于颅内动脉瘤的观察和诊断；MMBE的自动去骨效果好，更节约手动减影时间，但易过度减影导致血管假性狭窄及动脉瘤显示不完整，总体减影效果差，不利于颅内动脉瘤的诊断。

Abstract:

Objective：To compare the subtraction effect of volume computed tomography digital subtraction angiography（VCTDSA） and computed tomography angiography with matched mask bone elimination（MMBE） of the head and neck in patients with intracra－nial aneurysm. Methods：A retrospective analysis was conducted on the data of 47 patients who underwent a computed tomography angiography（CTA） of the head and neck and were diagnosed with intracranial aneurysm in our hospital from March 2017 to March 2018. The original images from the head and neck CTA of the above 47 patients were post-processed using the VCTDSA technique on a GE AW4.6 workstation and the MMBE technique on a SIEMENS Syngovia workstation，respectively；the two techniques were compared in terms of automatic subtraction time，manual subtraction time，and total subtraction time；moreover，the bone removal effect after subtraction，blood vessel subtraction effect，and aneurysm display effect were also evaluated. Results：There were significant dif－ferences between VCTDSA and MMBE in the automatic subtraction time，manual subtraction time，and total subtraction time（12 s vs. 76 s，598 s vs. 288 s，and 561.5 s vs. 375 s，respectively）. VCTDSA was significantly superior to MMBE in the subtraction effect of the intracranial segment and the venous sinus of the internal carotid artery as well as in the aneurysm display effect（P<0.01），but was significantly inferior to MMBE in the bone removal effect after subtraction（P<0.01）. For aneurysms of the internal carotid artery siphon，VCTDSA was significantly superior to MMBE in the a－neurysm display effect（P<0.01）. Conclusion：VCTDSA has a high speed of automatic bone removal with a satisfactory effect，and is superior to MMBE in the display effect of blood vessels and aneurysms of the head and neck，which contributes to the observation and diagnosis of intracranial aneurysms. MMBE has a better automatic bone removal effect and can reduce manual subtraction time，but it may achieve a poor overall subtraction effect due to false vascular stenosis and incomplete display of aneurysms caused by excessive subtraction，which is not conducive to the diagnosis of intracranial aneurysms.