C臂锥形束CT在肝癌介入治疗中监测栓塞效果的价值

探讨C臂锥形束CT在肝癌介入治疗中监测栓塞效果的价值。选取2016年1月—2017年1月我院治疗的20例肝癌介入手术患者,采用C臂锥形束CT和常规DSA检查,二者在肝癌诊断中的检测效果和栓塞效果。20例肝癌患者共82个肿瘤,术中常规DSA发现病灶60个(73.17%),C臂锥形束CT发现病灶80个(97.56%),检出率明显高于常规DSA (χ2=19.5238,P=0.000)。阳性一致率为75%(60/80),总一致率为75.61%,Kappa值为0.13,两者一致性差。对病变栓塞效果进行观察,20例患者中二者显示结果不一致的病例5例,需要寻找其他供血动脉进行栓塞。普通DSA未能明确显示肿瘤供血血管;锥形束CT重建图像可以清晰显示血管走形,能够清晰观察到血管内碘油沉积情况。C臂锥形束CT能够有效提高肝癌介入治疗准确率,较常规DSA检查更有优势。     

C臂锥形束CT颅内血肿体积定量测量的实验研究

目的探测C臂锥形束CT对颅内血肿的定量检测能力。方法于小气球内装对比剂与水的混合物模拟颅内血肿,并按体积分为9组,每组分别接受3次MSCT和3次C臂锥形束CT扫描,将两种成像技术所得图像进行MPR,采用西门子公司的体积测量软件对每组测量3次,计算与真实体积的偏差度,并进行统计学分析。结果对于形态规则的血肿,C臂锥形束CT测量血肿体积的准确率较高,与实际血肿体积和MSCT相比差异均无统计学意义(P0.05)。对于形态不规则的血肿,在测量30ml或60ml的血肿体积时,C臂锥形束CT测量体积与实际体积相比存在误差(P0.05);测量体积为30~60ml血肿时,C臂锥形束CT测量体积与实际体积基本一致(P0.05);MSCT测量体积准确率明显高于C臂锥形束CT(P0.05)。结论合理选择C臂锥形束CT颅内血肿定量检测范围,在介入诊治中有效监测颅内出血。     

C臂CT在经导管动脉化疗栓塞术治疗肝脏恶性肿瘤中的应用

目的探讨平板探测器C臂CT在TACE治疗肝脏恶性肿瘤中的应用价值。方法 38例肝脏恶性肿瘤患者在常规DSA基础上接受C臂CT检查,观察C臂CT是否能提供更多影像信息及其对介入治疗方案的影响;对C臂CT图像进行伪影分级评分并对其中28例患者C臂CT图像与近期MSCT图像比较,评价其图像质量;分析观察者间一致性。结果与常规DSA比较,C臂CT为26例（26/38,68.42%）提供了更多的影像信息,9例（9/38,23.68%）最初通过常规DSA制定的介入治疗方案因而改变;C臂CT图像质量评分为2.68,稍差于MSCT。所有患者C臂CT图像均有不同程度伪影。在C臂CT图像质量、伪影等级评分、C臂CT是否提供额外影像信息及对介入治疗方案的影响方面,观察者之间有良好的一致性（Kendall＇s W系数分别为0.78、0.84、0.73及0.67）。结论平板探测器C臂CT可在常规DSA基础上提供更多的影像信息,有助于提高肝脏恶性肿瘤TACE的疗效及安全性。     

C臂CT在神经介入中的应用进展

C臂CT是平板探测器数字减影血管造影系统上的一种新技术,随着成像技术的改进,C臂CT系统功能不断增强,已被广泛应用于神经介入术,其在支架显影成像、软组织成像、灌注成像方面的应用给神经介入带来了极大的便利。本文对C-臂CT系统在神经介入中应用的最新进展以及其对临床工作的巨大指导意义进行综述。     

C臂CT在胸部介入诊疗中的应用现状

随着C臂CT技术的快速发展,其在胸部介入诊疗中的应用日益增多。对于如何优化C臂CT在胸部介入诊疗中的应用流程、降低辐射剂量,有待进一步研究。本文对C臂CT技术在胸部介入诊疗中的应用进行综述。     

CT、C臂机联合导引下椎体成形术治疗椎体压缩性骨折

目的探讨CT、C臂机联合导引下椎体成形术（PVP）治疗压缩性骨折的效果及穿刺方法。方法接受PVP治疗的181例压缩性骨折患者的207个椎体进入研究。治疗在CT、C臂机联合导引下进行,经单侧椎弓根斜向进入椎体中央前1/3,注入骨水泥。结果全部椎体完成PVP,患者无严重并发症发生。术后随访有效率95.58%。结论CT、C臂机联合导引下PVP安全、有效。     

64排CT与DSA及C臂 CT检出肝癌小病灶的对比

目的比较64排CT、DSA和C臂CT对肝癌小病灶（直径≤3.0 cm）的检出能力。方法对48例肝癌患者先行64排CT扫描,再行肝动脉DSA、TACE和C臂CT扫描。2周内复查CT（碘化油CT）,由3名影像科医师对64排CT、DSA、C臂CT和碘化油CT图像进行分析,计数4种方法对直径≤3.0 cm病灶的显示情况,并以碘化油CT诊断结果作为标准,用McNemar检验比较64排CT、DSA和C臂CT诊断肝癌小病灶的检出率。结果碘化油CT证实48例患者共133个病灶（直径0.5~3.0 cm）,其中64排CT检出55个（55/133,41.35%）,DSA检出110个（110/133,82.70%）,C臂CT检出130个（130/133,97.74%）,三者间两两比较,差异均有统计学意义（P〈0.0001）。根据病灶大小将133个病灶分为3组,A组（直径0.5~1.0 cm）98个病灶,B组（直径1.1~2.0 cm）27个,C组（直径2.1~3.0 cm）8个。64排CT、DSA、C臂CT分别检出A组病灶29、76和95个,B组19、26和27个,C组7、8和8个。结论 C臂CT可提高对肝癌小病灶的检出率。     

螺旋CT辅助定位联合C型臂行微创经皮肾镜取石术

目的：探讨螺旋CT辅助定位联合C型臂在微创经皮肾镜取石术中的应用价值。方法：对15例输尿管上段结石、43例肾结石共58例63侧患者（CT组）在行经皮肾镜取石术前先行俯卧位螺旋CT扫描,确定穿刺点、穿刺角度和深度,术中据CT测量结果行盲穿,穿刺成功后及碎石毕再行c型臂检查以明确穿刺针及导丝进入肾脏收集系统位置、结石有无残留及部位,并与同期8例输尿管上段结石、23例肾结石共31例33侧（C臂组）直接在c型臂下行微创经皮肾镜取石术者进行比较。结果：CT组58例63侧平均穿刺1．22次,C型臂平均使用2．22次,均明显低于C臂组31例33侧的1．79次和4．52次（t=3．538,P=0．001和t=6．614,P=0．001）;但CT组残石率为22．22％（14／63）,与c臂组残石率30．30％（10／33）比较,差异无统计学意义（X^2=0．754,P=0．385）。结论：螺旋CT辅助定位联合C型臂行微创经皮肾镜取石术能有效提高经皮。肾穿刺成功率并减少C型臂的应用,降低X线的辐射量,尤其适用于复杂肾结石的微创治疗及该项业务的推广应用。     

多层螺旋CT血管造影在肺部疾病介入治疗中的应用价值

目的探讨多层螺旋CT血管造影（MSCTA）及三维重建对肺部疾病介入治疗的指导价值。方法对32例肺部疾病患者，介入治疗前行MSCTA检查，并应用最大密度投影（MIP）、容积再现技术（VRT）对血管进行三维重建。结果32例患者共进行MSCTA检查及三维重建41次，共发现供血动脉形成57支。结论在肺部疾病介入治疗前行MSCTA检查及三维重建，能直观、清晰地显示供血血管的数量和起源，有利于降低手术难度，减少对比剂的用量和曝光时间，对制定手术方案具有重要指导意义。     

数字减影脑血管造影术的护理

数字减影血管造影术(Digital Subtraction Angio-graphy,DSA)是影像学领域继超声、CT 以后第三次重大的技术突破。我院1986年底引进法国 CGR 公司ANGIOMAX 双 C 臂 X 光机及 D、I、V、A、s 通用数字减影血管造影检查仪,在广东地区首先应用于中枢神经系统疾病的诊治,效果尚满意。现将我们的     

Intraoperative cone-beam CT for guidance of temporal bone surgery.

OBJECTIVES: To describe our preclinical experience with Cone Beam CT (CBCT) in image-guided surgery of the temporal bone. STUDY DESIGN AND SETTINGS: A mobile isocentric C-arm (PowerMobil, Siemens Medical Systems, Erlangen, Germany) modified to include a flat-panel detector (Varian Imaging Products, Palo Alto, CA) and a motorized orbit was developed to acquire multiple projections in rotation about a subject. Initial experiments imaging steel wire in air were used to investigate the system's spatial resolution in 3D image reconstruction. Subsequently temporal bone dissection was performed on five cadaver heads using the modified C-arm as an image guidance system. RESULTS: We obtained a spatial resolution of 0.85 mm. The image acquisition time was 120 seconds and the radiation dose approximately one-tenth of a conventional CT scan. CONCLUSION: CBCT provided submillimeter accuracy at high speed with low radiation dosage to offer utility as an intraoperative imaging system. SIGNIFICANCE: CBCT offers technology that approximates "near-real-time" image guidance. EBM rating: C-4.     

The creation of the optimal dedicated endovascular suite.

BACKGROUND: During the last decade endovascular therapy has been established as an alternative treatment for a variety of vascular diseases. Neither the classic operating room (OR), nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues include: quality of the imaging equipment, radiation burden, ease of use of the equipment, need for specially trained personnel, ergonomics, ability to perform both open and percutaneous procedures, sterile environments, as well as quality and efficiency of patient care. METHODS: A literature search identified articles pertinent to the key issues during the decision-making process of creating the optimal endovascular suite. Manual cross-referencing also was performed. RESULTS AND CONCLUSION: The most important feature of working in a dedicated endovascular suite should be the ability to attain best treatment of vascular patients. Whether the interventional radiologist or the vascular surgeon uses the facilities is of less importance. A fixed fluoroscopy unit is preferred, above a portable C-arm. Establishment of an endovascular operating room suite has the benefit of a sterile environment, the possibility of performing hybrid procedures and conversions when necessary. Moreover, angiography immediately before treatment gives contemporary anatomical information, and after treatment provides quality control. As a consequence, better quality and service can be provided to the individual patient.     

Intraoperative cone-beam CT for image-guided tibial plateau fracture reduction.

OBJECTIVES: A mobile isocentric C-arm was modified in our laboratory in collaboration with Siemens Medical Solutions to include a large-area flat-panel detector providing multi-mode fluoroscopy and cone-beam CT (CBCT) imaging. This technology is an important advance over existing intraoperative imaging (e.g., Iso-C(3D)), offering superior image quality, increased field of view, higher spatial resolution, and soft-tissue visibility. The aim of this study was to assess the system's performance and image quality in tibial plateau (TP) fracture reconstruction. METHODS: Three TP fractures were simulated in fresh-frozen cadaveric knees through combined axial loading and lateral impact. The fractures were reduced through a lateral approach and assessed by fluoroscopy. The reconstruction was then assessed using CBCT. If necessary, further reduction and localization of remaining displaced bone fragments was performed using CBCT images for guidance. CBCT image quality was assessed with respect to projection speed, dose and filtering technique. RESULTS: CBCT imaging provided exquisite visualization of articular details, subtle fragment detection and localization, and confirmation of reduction and implant placement. After fluoroscopic images indicated successful initial reduction, CBCT imaging revealed areas of malalignment and displaced fragments. CBCT facilitated fragment localization and improved anatomic reduction. CBCT image noise increased gradually with reduced dose, but little difference in images resulted from increased projections. High-resolution reconstruction provided better delineation of plateau depressions. CONCLUSION: This study demonstrated a clear advantage of intraoperative CBCT over 2D fluoroscopy and Iso-C(3D) in TP fracture fixation. CBCT imaging provided benefits in fracture type diagnosis, localization of fracture fragments, and intraoperative 3D confirmation of anatomic reduction.     

Hybrid coronary artery revascularization: logistics and program development

Planning hybrid coronary artery revascularization--a combination of cardiac surgery with percutaneous procedures--requires, at first sight, a very complex logistical setup. Technical and equipment related details should be defined as early as possible in order to have time for training of all OR personnel involved. The most challenging aspect in OR-located hybrid coronary revascularization remains a very close cooperation of cardiac surgeons and interventional cardiologists. This teamwork does include indication findings and subsequent referral of multivessel coronary artery disease patients to hybrid procedures, as well as high individual flexibility of interventionalists and surgeons. The major prerequisite for this cooperation is a mutual acceptance of different revascularization approaches and the intent to combine their most striking advantages. Intraoperative graft angiography during coronary artery bypass grafting (CABG) procedures is one important step toward simultaneous hybrid coronary revascularization procedures. We describe our experience with on table angiography using a mobile C-arm for intraoperative imaging. This fluoroscopy system can in selected cases be used for simultaneous hybrid procedures.     

Endovascular operating suite: future directions for treating neurovascular disease

OBJECT: The purpose of this study was to evaluate initial experiences in a surgical operating room (OR) with a multipurpose angiography unit, which offers integrated neurosurgical and radiological capabilities. METHODS: A specially designed biplane digital subtraction (DS) angiography system was installed in the neurosurgery OR. The new suite, which allows three-dimensional DS angiography with C-arm for computerized tomography and microsurgery capabilities, allows the neurosurgeon to perform a wide range of neurosurgical and endovascular procedures. Three hundred thirty-two procedures were performed in the endovascular OR between November 2003 and March 2005. Patients arriving in the emergency department were transferred to the endovascular OR without delay. The neurovascular team performed diagnostic angiography followed by endovascular interventional procedures or surgery. CONCLUSIONS: The newly designed endovascular OR facilitates safe and systemic treatment of neurovascular disease.     

经肝动脉化疗栓塞联合C臂CT引导微波消融治疗肝癌

目的观察经导管肝动脉化疗栓塞(TACE)联合C臂CT引导微波消融(MVA)治疗肝癌的效果,评价以C臂CT动脉灌注成像评估消融范围的可行性。方法 47例肝癌(63个病灶)接受TACE联合C臂CT引导MVA治疗,于消融后即刻行经动脉插管C臂CT灌注成像判断消融范围,记录技术成功率,比较消融后即刻C臂CT与术后24 h内增强CT所示消融灶最大横径和纵径。术后随访观察治疗效果。结果对63个病灶均顺利完成TACE联合MVA治疗,技术成功率100%。消融术后即刻C臂CT测量消融灶最大横径和纵径分别为(3.44±0.95)cm和(4.13±1.01)cm,术后24 h内增强CT显示最大横径和纵径分别为(3.46±0.95)cm和(4.14±1.02)cm,差异均无统计学意义(P均0.05)。术后2例发生右侧反应性胸腔积液(积液量均100 ml),6例发热,未见其他不良反应。术后1个月,38个2.50 cm病灶完全坏死(38/38,100%);25个≥2.50 cm病灶中,24个完全坏死(24/25,96.00%)。术后随访6～25个月,仅2个病灶局部进展(2/63,3.17%),其余病灶未见进展或复发征象。结论 TACE联合C臂CT引导微波消融治疗肝癌安全有效;C臂CT灌注成像可准确评估消融范围。     

CT仿真局部解剖与X线透视双导向的软组织金属异物钳取术

目的探讨CT仿真局部解剖与X线透视双导向软组织金属异物钳取术的临床应用价值。方法 1315例软组织金属异物患者分为平片组、平片加常规CT组和平片加CT仿真局部解剖组。采用体绘制和动态阈值技术以获取CT仿真局部解剖图像,根据影像学资料先行评价、确定异物钳取术的可行性及具体术式,在"C"型臂X线电视透视引导下经皮钳取异物。结果应用动态阈值变化的体绘制技术的CT仿真局部解剖图像成功获得率为100%,基于增强CT源影像的图像层次丰富,且三维显示了基于平扫源影像未能重构出来的动脉与深部静脉。CT仿真局部解剖准确评估了异物的可摘除性、手术风险,并由此确定了具体术式。平片加CT仿真局部解剖组异物介入摘除术的安全性、成功率与治愈率明显高于其他两组(P0.01),手术时间和住院时间短于其他两组(P0.05),并发症发生率和定位器协同使用率低于其他两组(P0.005)。结论 CT仿真局部解剖结合X线透视双导向软组织金属异物钳取术具有良好的临床价值与效果。