The Application Of Combined DSA With MRI Image Technique In Gamma Knife Treatment Of Intracranial Arteriovenous Malformation

Objective : Microsurgical resection,endovascular embolization,stereotactic radiosurgery(SRS)and comprehensive treatment have become the main methods for the treatment of intracranial arteriovenous malformation(bAVM).Related studies have confirmed that SRS treatment is an important treatment for bAVM,with the advantages of exact curative effect,small trauma and low complication rate.In this treatment method,how to improve the accuracy of target delineation has an important effect on improving the therapeutic effect;however,since the bAVM has a shape that is usually irregular,and the blood supply artery,the malformed vascular group and the drainage vein often overlap,the precise location of the lesion is caused.Very difficult.Gamma Knife(GKRS)treatment is the gold standard for SRS treatment.At present,the commonly used localization methods in the localization of GKRS in bAVM include: MRI+CT,MRI+DSA,MRI+MRA,CT+DSA and single image localization.The combination of the two types is better,and MRI+MRA and MRI+DSA are the most widely used in localization;The positioning methods have their own advantages.CT and MRI have obvious defects in the display of small arteries and drainage veins,but their display effect on surrounding tissue structure is remarkable.MRA has unique advantages in the detection of bAVM,which can clearly show the size of blood vessel nests.,location,morphology,internal structure,but susceptible to hematoma and other factors,DSA is currently recognized gold standard,is the most accurate method for the diagnosis of bAVM,but the effect is not good in showing the three-dimensional structure of the blood vessel nest,the adjacent tissue adjacent relationship;Therefore,the combination of multiple images and complementary advantages,in order to obtain systematic,objective and accurate localization of imaging data before the development of treatment plans to improve the treatment effect and reduce complications is the current trend of GKRS treatment bAVM.There are few reports on the combination of MRI+MRA+DSA three kinds of image data for GKRS treatment bAVM.This paper discusses the technical points of using DSK,MRI and MRA image data in Leksell Stereotactic system and combining bAVM in Leksell Gammaplan.Compare the three imaging data combinations of MRI+MRA+DSA with MRI+MRA and MRI+DSA images in the GKRS treatment bAVM to locate the imaging effect and delineate the difference in treatment volume.Methods:We selected 60 patients with cerebral vascular malformation admitted to our Gamma Knife Center from August 2017 to December 2018.According to the exclusion criteria,35 patients were diagnosed by DSA before the stereotactic radiosurgery treatment.After the establishment of the spatial coordinate system,all the nuclear magnetic and DSA examinations were carried out.The three kinds of image data combinations of MRI+MRA+DSA and MRI+MRA and MRI+DSA were combined to analyze the imaging effect and delineation in GKRS treatment bAVM.The difference in treatment volume.Observation items: mainly include blood supply artery,drainage vein,blood vessel nest,target volume size and positioning error of vascular nest.SPSS24.0 statistical software.Analyze and compare the three imaging data combinations of MRI+MRA+DSA and the combination of MRI+MRA and MRI+DSA image data in the GKRS treatment bAVM to locate the imaging effect and delineate the difference in treatment volume.Perform t test,select value<0.05.Significant for the difference.Results:According to the score of the bAVM localization imaging effect in our department,the mean score of MRI+DSA+MRA group was 12.3,which was significantly higher than that of MRI+MRA group(10.3)and MRI+DSA group(10.4),P<0.05;MRI+DSA.The mean treatment volume(2.08cm3)in the +MRA group was significantly different from the MRI+MRA group(1.93cm3)and the MRI+DSA group(1.95cm3)group,P<0.05.Conclusion:1.The combination of three kinds of image data of MRI+DSA+MRA can improve the imaging effect of bAVM positioning.2.The combination of MRI+DSA+MRA three kinds of image data can improve the accuracy of the treatment target area and make the lesions more comprehensive.3,GKRS is also an effective and safe method for microsurgery,endovascular embolization,or postoperative residual.