| Objective The value of digital subtraction three-dimensional reconstruction technology(3D-DSA)in the diagnosis and treatment of intracranial aneurysms has been widely recognized and accepted.Compared with conventional digital subtraction angiography(2D-DSA),It not only improves the accuracy of diagnosis,but also provides a reliable basis for formulating a reasonable treatment plan by accurately displaying the aneurysm's own morphology and its relationship with surrounding blood vessels.The double-volume reconstruction(DVR)developed on the basis of three-dimensional reconstruction technology has obvious advantages in evaluating the effect of intravascular embolization of aneurysms.The purpose of this study was to analyze and compare the 2D-DSA and 3D-DSA detection rates of intracranial aneurysms,the aneurysm neck and the relationship between adjacent aneurysms,and the radiation doses and contrast agents used by patients during their respective examinations.The differences in quantity and other aspects,and the comparison of the application of 2D-DSA,3D-DSA and DVR after intravascular embolization of aneurysms,and the application value of 3D-DSA and DVR in the diagnosis of intracranial aneurysms and intravascular embolization treatment.Methods A retrospective analysis of the data of a total of 138 patients with subarachnoid hemorrhage who underwent 2D-DSA and 3D-DSA examinations consecutively from January 2018 to December 2019 in my hospital,all patients were treated with 2D-DSA and 3D-DSA inspection technology,independently analyzed by 2neuroradiologists and 1 imaging technician,record the detection of aneurysms,neck display,radiation dose received by patients and the amount of contrast agent.Analyze the differences between 2D-DSA and 3D-DSA showing intracranial aneurysms,and find the best display angle of aneurysms through 3D-DSA.For aneurysms that can be selected for interventional treatment,develop an intravascular embolization treatment plan.Immediate spring coil embolization was performed on 98 of these aneurysms.After the embolization was completed,DSA angiography,3D-DSA and dual volume reconstruction techniques were selected.Raymond classification was used todetermine the degree of embolization after aneurysm: Grade I was completely embolized without contrast contrast;Grade II tumors remained with a small amount of neck;Grade III tumors remained partially.Results A total of 162 aneurysms were detected in 128 of the 138 SAH patients,of which 2D-DSA detected 144 aneurysms in 114 patients and 3D-DSA detected a total of 162 aneurysms in 128 patients.10 cases were diagnosed with aneurysms in 2D-DSA,3D-DSA confirmed normal vascular reentry and funnel-like dilatation,14 cases did not find aneurysms in2D-DSA,and 18 microaneurysms were diagnosed in 3D-DSA.Of the 162 aneurysms,2D-DSA and 3D-DSA were detected in aneurysms with a diameter of> 5mm,and there was no statistical difference;3D-DSA showed clear 162 aneurysm necks and their relationship with tumor-bearing vessels.It was shown that2D-DSA only showed a clear display of some of the aneurysms,and the two showed statistically significant differences in the relationship between the aneurysm neck and adjacent blood vessels(Z =-6.708,P <0.01)Among the 28 aneurysms with a diameter of less than 5mm,only 2 were detected by 2D-DSA and all were detected by3D-DSA.The sensitivity of 2D-DSA and 3D-DSA to the diagnosis of aneurysms was88.5% and 100%,respectively.;Specificity is 37.5% and 100%,respectively.The statistical comparison of the amount of contrast agent used by 2D-DSA and 3D-DSA and the radiation dose received by patients during the two tests were statistically significant.After 98 aneurysm embolization,2D-DSA showed 54 grade I embolism,32 grade II,12 grade III;3D-DSA showed 32 grade I,40 grade II,and 26 grade III;DVR showed sequentially There were 28 in grade I,36 in grade II,and 34 in grade III.The three had statistically significant differences in the degree of aneurysm residual after intravascular embolization of aneurysms(H = 10.353,P <0.05).Conclusion(1)3D-DSA significantly improves the detection rate of intracranial microaneurysms.It has higher sensitivity and specificity than 2D-DSA,especially in describing the shape and size of aneurysms and the spatial position of the aneurysms Relationships have unparalleled advantages.(2)3D-DSA technology can more accurately judge the possibility of successful intravascular treatment of aneurysms and provide the best working angle for the smooth implementation of embolization treatment.It can also accurately measure the size of the aneurysm,which helps determine the size of the first coil,and provides a guarantee for dense embolization of the aneurysm.(3)The application of 3D-DSA significantly reduces the radiation dosereceived by patients,and also reduces the use of contrast agents.It has a great effect on improving the safety of radiation protection and reducing the risk of contrast-induced nephropathy in patients after surgery.s help.(4)In judging the degree of intracranial aneurysm embolization and follow-up after interventional intervention,the double volume reconstruction technology provides more imaging information than 2D-DSA and 3D-DSA,and has more application advantages.(5)The3D-DSA image is only a reconstructed image,which cannot provide hemodynamic changes of blood vessels,and still cannot completely replace the conventional2D-DSA. |
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