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目的探讨三维影像融合在软脑膜动静脉瘘(p AVF)诊断与治疗中的应用价值。方法回顾性分析三家医院2014年9月到2015年2月收治的5例p AVF患者的临床资料。患者三维影像在Siemens Artis Zee Biplane双大平板DSA机的SystemSyngo X-WP三维后处理工作站上应用融合软件自动融合。分析3D-DSA双血管融合、CT/MR影像融合、3D-DSA/Dyna-CT影像融合,用于协助诊断与实施血管内治疗。从供血动脉、瘘口形态和位置、引流静脉及动静脉瘘与相邻脑结构的空间关系这4个方面来评价三维影像融合对诊断与治疗的应用价值。结果 3D-DSA双血管、MR/CT及3D-DSA/Dyna-CT等三维影像融合,可以把3D-DSA提供的血管系统信息与MR影像或Dyna-CT影像信息通过后处理融合在一张图像上,实现同步可视,将病变的双重血供和病变与脑组织、颅神经及颅骨的解剖关系显示清楚。5例患者的3D-DSA双血管、MR/CT或3D-DSA/Dyna-CT影像融合比未融合资料在对上述4个方面的评估上更具有价值,对诊断和手术更有意义。结论三维融合影像更有助于对p AVF进行术前评估和设计手术计划,特别是有助于术前更好地理解病变的解剖特点和对栓塞材料的选择。
Objective To explore the value of three-dimensional image fusion in the diagnosis and treatment of leptomeningeal arteriovenous fistula (p AVF). Methods The clinical data of 5 patients with p AVF admitted from September 2014 to February 2015 in three hospitals were retrospectively analyzed. Patient 3D images were automatically fused using fusion software on a SystemSyngo X-WP 3D post-processing workstation on the Siemens Artis Zee Biplane double-panel DSA machine. Analysis 3D-DSA bi-vascular fusion, CT / MR imaging fusion, 3D-DSA / Dyna-CT image fusion, to assist in the diagnosis and implementation of endovascular treatment. From the four aspects of the feeding artery, the shape and location of the fistula, the drainage veins and the spatial relationship between the arteriovenous fistula and the adjacent brain structure, the application value of the three-dimensional image fusion in the diagnosis and treatment is evaluated. Results The 3D fusion of 3D-DSA bi-vessel, MR / CT and 3D-DSA / Dyna-CT could be used to integrate the information of vascular system provided by 3D-DSA and MR or Dyna-CT image information into one image On the realization of simultaneous visualization, the lesions of the double blood supply and lesions and brain tissue, cranial nerves and skull anatomy showed clearly. The fusion of 3D-DSA bi-vascular, MR / CT or 3D-DSA / Dyna-CT images in 5 patients was more valuable than the unfused data in the evaluation of the above four aspects, which is more meaningful for diagnosis and surgery. Conclusions 3D fusion imaging is more helpful for the preoperative evaluation and design of surgical planning for p AVF, especially for better understanding of the anatomic features of lesions and the selection of embolic materials.