Applications For Three-dimensional Digital Subtraction Angiography And Dual-volume Reconstruction Technique In The Diagnosis And Treatment Of Intracranial Aneurysms

Objective The value of three dimensional digital subtraction angiography technique(3D-DSA) in the diagnosis and treatment of intracranial aneurysms is becoming widely recognized and accepted more and more in recent years. Compared to conventional digital subtraction angiography (2D-DSA), not only to improve the accuracy of diagnostic but also to display aneurysm and its relationship with surrounding vessels better by 3D-DSA, which provide reliable basis to reasonable treatment. Double volume reconstruction (DVR) technique comes from the 3D reconstruction technology originally there is the obvious advantage in evaluation of aneurysm endovascular embolization effect. In this study some samples were analyzed and compared each other which the aneurysm detective rate, visualization of aneurismal neck and neighboring vessels, and the radiation dose which patients received and dosages of contrast medium to be detected also between 2D-DSA and 3D-DSA. Three methods were used to compare their application value in intracranial aneurysm after endovascular to explore the applicative value of 3D-DSA and DVR in diagnosis and endovascular treatment of intracranial aneurysm.Methods 69 cases with subarachnoid hemorrhage (SAH) during Jun 2013 to Nov. 2013 were analyzed retrospectively. All patients had undergone angiography with both 2D-DSA and 3D-DSA, and the results were analyzed by 2 neuroradiologists and 1 imaging technician, the aneurysm detective rate visualization of aneurismal neck and radiation dose patients received and dosages of contrast medium were recorded espectively. The differences of intracranial aneurysm that 2D-DSA and 3D-DSA had showed were analyzed, The best angle for displaying aneurysms through 3D-DSA, aneurysm suitable to interventional therapy was made endovascular embolization treatment plan. A total of 49 patients with intracranial aneurysm underwent the coil embolization immediately, including DSA,3D-DSA and DVR had been done at work angel after the embolization. The outcomes after the embolization were judged by Raymond classification:class I was embolized completely, no contrast medium was displayed, aneurismal neck remnant was displayed at class II. aneurismal body remnant was detected at class III.Results 64 cases with 81 aneurysms were detected out of 69 patients with SAH,54 patients of them with 72 aneurysms were detected out by 2D-DSA,64 patients with 81 aneurysms were found by 3D-DSA.5 cases underwent 2D-DSA were deemed to aneurysm, but normal tortuous vessels and infundibular dilations were confirmed by 3D-DSA.7 cases underwent 2D-DSA were negative, while 9 very small aneurysms were diagnosed by 3D-DSA.Aneurysms with diameter more than 5 mm were detected all by both 2D-DSA and 3D-DSA in 81 aneurysms, there were no statistical differences between the detective rates. The relationship between aneurismal neck and its relation to parent arteries of all the aneurysms could be displayed clearly by 3 D-D SA, while only part of the aneurysms could be showed clearly by 2D-DSA, there was a statistically significance in displaying the relationship between the aneurysmal neck and adjacent vessels (Z=-6.707, P< 0.01), Only 5 aneurysms were detected out by 2D-DSA of all the 14 aneurysms with diameter less than 5 mm, all the aneurysms were found out by 3D-DSA, The sensitivity of 2D-DSA,3D-DSA on the diagnosis of aneurysm were 88.5%,100% respectively; specificity were 37.5%,100% respectively, there were statistically differences in radiation dose and dosages of contrast medium of the 2D-DSA and 3D-DSA.About 49 aneurysms, the outcomes after the embolization underwent 2D-DSA were Ramond class â…  in 27cases, class â…¡ in 16cases, class â…¢ in 6 cases, the outcomes underwent 3D-DSA were Ramond class â…  in 16cases, class â…¡ in 20cases, class â…¢ in 13 cases, the outcomes underwent DVR were Ramond class I in 14cases, class â…¡ in 18cases, class â…¢ in 17. There was a statistical significance between 2D-DSA 3D-DSA and DVR (H=10.353, P< 0.05) when detecting an aneurysm remnant after the embolization.Conclusions 1. The detection rate of very small aneurysms can be improved by 3D-DSA which has a higher sensitivity and specificity than that of 2D-DSA. About 3D-DSA it has obvious advantages in displaying the shape of aneurysms, aneurismal neck and its relation to parent artery.2. By 3D-DSA there is the feasibility to evaluate the embolization treatment of intracranial aneurysms, and provides an optimum working angle, at the same time, the usage of contrast medium and radiation dose of the patients are reduced by 3D-DSA, which plays an important role in diagnosis and treatment of intracranial aneurysm.3. The follow-up information had been gotten much more from DVR than from 2D-DSA and 3D-DSA after the embolization of intracranial aneurysm.