虚拟现实手术计划系统在颅内动脉瘤诊治中的应用

目的 探讨虚拟现实手术计划系统在颅内动脉瘤诊治中的应用价值.方法 应用虚拟现实手术计划系统对61例颅内动脉瘤手术患者进行诊断及术前计划,分析手术计划系统对颅内动脉瘤的诊断价值、分析手术计划与手术操作之间的关系.结果 所有手术病例均显示术前诊断、术前计划与手术所见相吻合.结论 虚拟现实手术计划系统是颅内动脉瘤辅助诊断的有益补充,并且对于指导颅内动脉瘤手术有意义.     

2D—DSA与R—DSA及3D—DSA在脑动脉瘤诊疗中的应用

目的 通过对比2D—DSA、R—DSA与3D—DSA在显示脑动脉瘤瘤体的大小、瘤颈的宽窄及与毗邻血管的关系,说明3D—DSA优于2D—DSA及R—DSA。方法42例资料完整的颅内动脉瘤患者均行2D—DSA、R—DSA及3D—DSA检查,常规2D—DSA检查后即行R—DSA检查,把R—DSA图像传送到3D工作站,由3D工作站生成容积再现图像（VR）。通过图像在对脑动脉瘤瘤体的大小、形态、瘤颈的宽窄与毗邻血管的关系等方面显示评价分析。对50个行血管内栓塞治疗动脉瘤的数据进行统计学处理。结果①动脉瘤的显示：2D—DSA未能发现3个动脉瘤,这些动脉瘤在R—DSA上为不确定。VR可以发现所有的动脉瘤。②图像的整体质量：2D—DSA可以清楚显示细小动脉,图像整体质量优于R—DSA和3D—DSA。（④动脉瘤形状的显示：VR明显优于2D—DSA和R—DSA。动脉瘤瘤颈和动脉瘤与毗邻血管的关系的显示：VR明显优于2D—DSA和R—DSA。结论3D—DSA在颅内动脉瘤诊疗方面优于2D—DSA和R—DSA。尤其是对动脉瘤颈宽窄的显示,对介入手术治疗有着重要的意义。     

SCTA与DSA对脑动脉瘤诊断价值的研究

目的:评价SCTA和DSA在颅内动脉瘤诊断和治疗中的价值。方法:对57例动脉瘤患者分别进行SC-TA及DSA检查。结果:57例患者经DSA检出72个动脉瘤,SCTA检出69个漏检了3个动脉瘤。12个伴有血栓的动脉瘤及7个伴有钙化的动脉瘤被SCTA检出,但未被DSA检出。结论:SCTA具有简单、快速、安全、无创等优点,可清晰显示动脉瘤及周围相邻空间结构并可发现血管壁及瘤颈的钙化,为制定手术方案提供详细的资料,具有很高的临床实用价值。     

256层螺旋CT血管成像诊断脑动脉瘤的价值并与DSA的比较

目的通过与数字减影血管造影(DSA)比较,探讨256层螺旋CT血管成像(CTA)诊断脑动脉瘤的价值。方法 190例脑动脉瘤患者行CTA检查,并均进行脑动脉DSA,对两种方法的表现进行回顾性分析,比较两者对脑动脉瘤的检出率,同时对CTA漏诊脑动脉瘤的原因进行分析。结果DSA诊断为脑动脉瘤190例,共228个病灶;行CTA检查,诊断脑动脉瘤172例,共210个病灶,CTA与DSA比较,检出率为92%;统计学检验结果提示两种方法无统计学意义(P0.05)。CTA漏诊动脉瘤的主要原因是去骨同时去掉近颅底的动脉瘤、主观上重建和观察欠缺、动脉瘤本身因素。结论 256层螺旋CT血管成像是诊断脑动脉瘤有价值的方法。了解CTA脑动脉漏诊原因,加以改进,能提高CTA对动脉瘤的检出率。     

脑血管CTA及DSA检查对颅内动脉瘤的诊断

颅内动脉瘤是常见病,发生率占人群的1％～14％,单发动脉瘤首次破裂出血住院病人的病死率为10％～15％,再次破裂出血住院病人的病死率为40％,实际上很多患者动脉瘤破裂出血后没能到医院即死亡。Pakarinen统计,首次破裂出血经保守治疗存活的病人,35％将在1a内再次破裂出血而死亡,51％将在5a内死亡,未破裂的颅内动脉瘤随访1～10a,每年动脉瘤破裂率为0．5％～2．2％,出血后发生严重     

VR技术在颅内动脉瘤手术术前计划中的应用

目的：在颅内动脉瘤手术前应用虚拟现实技术进行术前计划和模拟手术。探讨虚拟现实技术的应用价值。方法：全组97例患者术前均行CTA或MRA检查,将影像数据已DICOM格式保存,传入VR系统工作站中,进行VR立体三维重建,从任意角度观察动脉瘤、载瘤动脉及比邻血管,确定手术方案,拟行动脉瘤夹闭术者进行VR模拟手术。结果：76例行动脉瘤夹闭手术,1例行颞浅动脉-大脑中动脉搭桥手术,16例行介入栓塞治疗,2例放弃治疗;手术患者术中所见与VR术前计划所见完全一致,术后无死亡病例。结论：虚拟现实术前计划系统可在术前提供充分的立体三维信息,模拟手术可帮助术者充分了解动脉瘤夹闭的可能性,有效降低手术意外的发生     

双螺旋CTA诊断脑动脉瘤的价值

目的　评价CTA诊断脑动脉瘤的价值。方法　 5 0例以 2～ 3ml/s从肘静脉注射碘造影剂 4 0～ 10 0ml,延迟 12～ 2 0s行连续容积扫描 ;资源图像输入独立工作站 ;采用多平面重建 (MPR)、最大密度投影 (MIP)、表面遮盖显示(SSD)和仿真血管微镜 (VM )重建 ;与DSA对比 ,并栓塞治疗。结果　①双螺CT扫描能在短时内完成数据采集 ;②MPR、MIP能准确显示动脉瘤的大小、部位 ,SSD、VM显示空间解剖及内腔效果好 ;③CTA与DSA有高相关性 (r >0 99)。结论　注重容积信息与多重建模式互补选择 ,CTA对脑动脉瘤具有重要诊断价值     

CTA及MRA对5mm及以上动脉瘤的诊断价值分析

目的探讨CTA和MRA用于诊断5mm及以上动脉瘤的价值比较。方法选择该院出现急性蛛网膜下腔出血或查体高度怀疑为颅内脑动脉瘤患者52例,随机分为CTA组和MRA组各26例,其中CTA组患者接受CTA＋DSA检查,MRA组给予MRA＋DSA检查,两组均以DSA检查及手术证实为标准,比较CTA及MRA5mm及以上动脉瘤的诊断价值。结果 CTA对于≥5mm动脉瘤检测的灵敏度、特异性、准确性与CE-MRA比较,差异无统计学意义（P〉0.05）,但是明显高于3DTOF-MRA,差异有统计学意义（P〈0.05）。结论 CTA由于对5mm及以上动脉瘤具有较高的灵敏度、特异性、准确性,可作为该类颅内动脉瘤检查的首选方法,CE-MRA也可作为其有效检查手段,但其检出率略低于CTA。     

3D-CTA、3D-DSA对颅内动脉瘤诊断价值的对比研究

目的对比分析64排螺旋CT三维血管造影（3D-CTA）与三维数字减影血管造影（3D-DSA）对颅内动脉瘤的影像学诊断价值。方法选取42例颅内动脉瘤患者,分别采用3D-CTA与3D-DSA检查,对比两种检查方法对颅内动脉瘤的诊断价值。结果手术结果显示。颅内动脉瘤共47个,3D-DSA检测结果与手术结果一致,检出敏感度100％;3D-CTA检出动脉瘤46个（其中误诊1个）,漏诊2个,检出敏感度95.7％（45／47）。结论3D-CTA与3D-DSA检查对诊断颅内动脉肿瘤具有极高的敏感性,均可作为临床诊断颅内动脉瘤的重要依据。     

脑动静脉畸形的对比影像诊断

目的：探讨脑内动静脉畸形CT、MRI、CTA、MRA、DSA等影像学诊断及与病理学表现的相关性。方法：本文收集颅内动静脉畸形75例。其中脑动静脉畸形66例，脑脑膜动静脉畸形1例。硬脑膜动静脉畸形1例．硬脑膜动静脉瘘7例，并经过CT、MRI、CTA、MRA、DSA及手术（病理）明确诊断。结果：CT呈团块状、蜂窝状、结节状、条索状、斑片状或斑点状；MR蚯蚓状或线样无信号流空血管影；CTA、MRA、DSA可见引入动脉影及引流静脉影，CT发现钙化及超早期出血较MR敏感。血管造影成像可以反映脑动静脉畸形的大体病理结构。结论：不同的影像手段对AVM的诊断各具有价值．结合不同的影像手段完全可以达到诊断定性的目的．影像表现可以反映AVM大体病理的表现。     

Virtual reality system for diagnosis and therapeutic planning of cerebral aneurysms

Background The virtual reality （VR） system can provide the neurosurgeon to intuitively interact with and manipulate the three dimensional （3-D） image similarly to manipulate a real object.it was seldom reported that the system was used in diagnosis and treatment of cerebral aneurysms.This study aimed to investigate the application of VR system in diagnosis and therapeutic planning of cerebral aneurysms.Methods A total of 24 cases of cerebral aneurysms were enrolled in this study from 2006 to 2008, which diagnosed by 3-D digital subtraction angiography （3D-DSA） or VR-based computed tomography angiographies （CTA）.The VR system and 3D-DSA system were used to observe and measure aneurysms and the adjacent vessels.The data of observation and measurements were compared between VR image and 3D-DSA image.All the patients underwent surgical plan and simulated neurosurgical procedures in the VR system.Results There were 28 aneurysms detected in VR system and 3D-DSA system.The VR system generated clear and vivid 3-D virtual images which clearly displayed the location and size of the aneurysms and their precise anatomical spatial relations to the parent arteries and skull.The location, size and shape of the aneurysms and their anatomical relationship with the adjacent vessels were similar between 3-D virtual image and 3D-DSA, but the spatial relationship between aneurysms and skull only been displayed by VR system.This VR system also could simulate simple surgical procedures and surgical environments.Conclusions The VR system can provide a highly effective way to provide precise imaging details as same as 3D-DSA system and assist the diagnosis of cerebral aneurysms with virtual 3-D data based on CTA.It significantly enhances the chosen therapeutic strategy of cerebral aneurysms.     

虚拟影像手术计划系统在颅内动脉瘤诊断中的应用

目的 探讨虚拟影像手术计划系统在颅内动脉瘤诊断中的应用价值.方法 选择54例经3D-CTA检查确诊的颅内动脉瘤患者,通过虚拟影像手术计划系统对原始CT图像进行三维重建,获得颅骨及脑血管的三维立体虚拟影像资料.对动脉瘤的位置、大小、形态及毗邻结构进行多角度观察和测量.利用系统的模拟手术工具对每例患者进行手术计划和模拟手术操作.结果 54例均成功地进行了三维立体虚拟影像重建和相关操作.该系统形成的虚拟图像清晰、逼真,可非常直观地显示动脉瘤的位置、大小、与载瘤动脉和颅骨的关系.利用该系统可进行简单的手术模拟操作.结论 虚拟影像手术计划系统可作为颅内动脉瘤的辅助诊断工具,利用该系统可获得更详细的动脉瘤影像学信息.     

多层螺旋CT血管造影与DSA诊断颅内动脉瘤的效果比较

目的:通过与数字减影血管造影(DSA)和外科手术结果对比,评价16层螺旋CT血管造影(CTA)对颅内动脉瘤诊断的准确性?方法:对356例临床怀疑颅内动脉瘤患者的16层螺旋CTA图像与DSA和外科手术结果进行回顾性对比研究?结果:结合CTA?DSA和术中所见,在356例患者中的195例患者颅内发现215个动脉瘤?5个动脉瘤CTA漏诊,9个动脉瘤在DSA检查中未能清楚显示,但被CTA发现,其中5个得到手术证实,另外4个未行手术治疗?16层螺旋CTA对于动脉瘤检出的敏感性与DSA的结果差别没有统计学意义?结论:16层螺旋CTA对于颅内动脉瘤检出具有很高的敏感性?特异性和准确性,在颅内动脉瘤的筛选?诊断和治疗方案的制定方面可以替代常规DSA检查?     

三维CT血管造影对动脉瘤性蛛网膜下腔出血诊断的可靠性研究

目的评价三维CT血管造影（3D-CTA）在动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage,aSAH）诊断的可靠性。方法对我科2010年12月-2011年11月间192名急性蛛网膜下腔出血患者行CT血管造影检查（CTA）检查并应用3D Slicer软件进行三维重建,与数字减影血管造影（digital subtraction angiography,DSA）或术中实际情况进行对比,评价CTA在动脉瘤性蛛网膜下腔出血诊断中的可靠性。结果 192例中,CTA检查出动脉瘤162例,脑血管畸形12例;另有假阴性1例,假阳性1例,均通过DSA及手术证实,3D-CTA在aSAH诊断的灵敏性为96.17%,特异性为94.11%。结论3D-CTA是动脉瘤性蛛网膜下腔出血的首选检查方法。     

三维数字减影血管造影对脑动脉瘤的诊断价值

目的：探讨三维数字减影血管造影（3DDSA）对脑动脉瘤的诊断价值。方珐：对91例确诊或疑诊脑动脉瘤患者的2DDSA和3DDSA检查结果进行回顾性对比分析，以呐动脉瘤手术和血管内治疗为参照。结果：91例患者3DDSA共检出64例92个动脉瘤，27例阴性，2DDSA共检出61例79个动脉瘤，30例阴性，2DDSA和3DDSA脑动脉瘤诊断阳性率比较差异无统计学意义（P〉0．05）。2DDSA有1例假阳性和4例假阴性，有10例13个动脉瘤朱被2DDSA发现（平均1．98ram），偶然发现未破裂动脉瘤占84．6％。3DDSA对于动脉瘤瘤颈的显示及瘤颈和周围重要血管毗邻关系的评价优于2DDSA（P〈0．01）。结论：3DDSA对于脑动脉瘤的诊断和治疗具有很大的临床应用价值。     

Combined application of virtual imaging techniques and three-dimensional computed tomographic angiography in diagnosing intracranial aneurysms

Background The diagnostic value of virtual imaging combined with three-dimensional computed tomographic angiography （3D-CTA） for intracranial aneurysms has not been fully elucidated yet. This study aimed to evaluate the value of combined application of virtual imaging techniques and 3D-CTA in diagnosing patients with aneurismal subarachnoid hemorrhage （SAH） at the acute stage. Methods Eighty patients with non-traumatic SAH received 3D-CTA examinations. The raw CT data of these patients were reconstructed and transferred into the 3D mode through the surgical plan system based on virtual reality （VR） image, and the 3D virtual images of skulls and brain blood vessels were acquired. The location, size and shape of aneurysms and their anatomic relationship with adjacent tissues were measured from many points of view. Results Seventy-three aneurysms were detected in 68 of the 80 patients, but 2 aneurysms were detected in 2 of the 5 patients who had been found free of aneurysms previously and had received 3D-CTA examinations for a second time one month later. The 3D virtual images produced by the virtual imaging system were clear and vivid, and they could reveal the location and size of the aneurysm and its relations to the parent artery and skull directly. Conclusions The imaging of 3D-CTA is convenient, reliable and fast in diagnosing intracranial aneurysms and can be regarded as the first choice for the diagnosis and treatment of ruptured intracranial aneurysms. Combined with the surgical plan system based on the VR image, 3D-CTA may obtain more imaging information about aneurysms.     

Preoperative surgical planning for intracranial meningioma resection by virtual reality

The Dextroscope Virtual Reality System had been applied to preoperative planning in brain lesions treatment for many years. This system could generate and display 3D graphics, and allow neurosurgeons working in stereo and in an environment which reproduces the real world conditions of manipulating objects with hand movements. In the study, we described our experience with the Dextroscope system in preoperative surgical planning and simulation for patients with intracranial meningiomas located on central groove area, anterior skull base and sphenoid ridge, and evaluated the clinical outcomes. We hope our work would guide for further clinical intracranial meningiomas therapy.     

Preoperative surgical planning for intracranial meningioma resection by virtual reality

Background  The Dextroscope system by Volume Interactions (Singapore) had been applied to minimally invasive neurosurgery in many units. This system enables the neurosurgeon to interact intuitively with the three-dimensional graphics in a direct manner resembling the way one communicates with the real objects. In the paper, we explored its values in pre-operation surgical planning for intracranial meningiomas resection.

Methods  Brain computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) were performed on 10 patients with parasagittal and falcine meningiomas located on central groove area; brain CT, MRI and magnetic resonance angiography (MRA) were performed on 10 patients with anterior skull base meningiomas and 10 patients with sphenoid ridge meningiomas. All these data were transferred to Dextroscope virtual reality system, and reconstructed. Then meningiomas, skull base, brain tissue, drainage vein and cerebral arteries were displayed within the system, and their anatomic relationships were evaluated. Also, the simulation operations were performed.

Results  For parasagittal and falcine meningiomas, the relationships of tumor with drainage vein and superior sagittal sinus were clearly displayed in the Dextroscope system. For anterior skull base and sphenoid ridge meningiomas, the relationships of tumor with bilateral internal carotid arteries, anterior cerebral arteries, middle cerebral arteries and skull base were vividly displayed within the virtual reality system. Surgical planning and simulation operation of all cases were performed as well. The real operations of all patients were conducted according to the simulation with well outcomes.

Conclusions  According to the virtual reality planning, neurosurgeons could get more anatomic information about meningioma and its surrounding structures, especially important vessels, and choose the best approach for tumor resection, which would lead to better prognosis for patients.

     

3D－CTA与DSA在颅内动脉瘤诊断和治疗中的比较

 ［目的］评价三维CT血管成像（3D－CTA）与DSA在颅内动脉瘤诊断和治疗中的应用价值。［方法］52例患者行3D－CTA与DSA检查，两者对照研究并以术中发现为准评估图像质量。［结果］本组动脉瘤44个，3D－CTA准确检出40个，DSA准确检出43个，两者检出能力无显著差异（P＞0.05）；根据术中发现，3D－CTA在瘤壁钙化、载瘤动脉的显示、瘤周解剖标志等方面，明显优于DSA（P＜0.05）。结论 随着CT机及软件的更新，3D－CTA可能取代DSA成为颅内动脉瘤诊断和治疗的首选。     

计算机断层扫描血管造影在脑动脉瘤诊断中的价值

目的：探讨运用计算机断层扫描血管造影（CTA）诊断脑动脉瘤的价值。方法：对2011年1至11月本科收治的79例自发性蛛网膜下腔出血患者进行CTA检查,然后进行全脑数字减影血管造影（DSA）。以DSA为“金标准”,计算CTA对脑动脉瘤诊断的敏感度和特异度。结果：本组79例患者CTA共检出46例52个动脉瘤,DSA检出48例55个动脉瘤;CTA检出非动脉瘤病灶52个,DSA检出非动脉瘤病灶56个。以DSA为“金标准”,CTA对脑动脉瘤诊断的敏感度为94．5％（52／55）,特异度为92．9％（52／56）。结论：使用CTA检测脑动脉瘤是一种可靠的方法。