DynaCT imaging for intraprocedural evaluation of flow-diverting stent apposition during endovascular treatment of intracranial aneurysms

The treatment of large, complex intracranial aneurysms is being increasingly performed using flow-diverting stents (FDS) such as the Pipeline Embolization Device (PED; ev3, Irvine, CA, USA). Malapposition of a FDS to the parent artery wall decreases the likelihood of aneurysm obliteration and increases the risk of both immediate and delayed complications. DynaCT scanning (Siemens Medical Solutions, Erlangen, Germany) is a novel imaging modality which uses a flat plane detector to generate CT images using the same C-arm employed for digital subtraction angiography. We present a 40-year-old woman with an unruptured, 11 mm cavernous internal carotid artery aneurysm who was treated with endovascular obliteration using a PED. Intraprocedural DynaCT scan performed after PED deployment demonstrated incomplete stent apposition to the parent vessel which could not be detected on digital subtraction angiography alone. Balloon angioplasty was performed to improve apposition of the stent to the vessel wall. There were no procedural or clinical complications. The aneurysm shrank in size at follow-up angiography 6 months after the procedure and will be monitored for progressive occlusion. While gross stent malapposition is readily evident after stent deployment, minor instances of malapposition may be undetectable by standard angiography. Therefore the use of DynaCT imaging may improve intraprocedural stent visualization and potentially avert long-term endovascular aneurysm treatment complications associated with inadequate stent apposition.     

Use of flat panel DynaCT myelography to locate the site of CSF leak

Spontaneous intracranial hypotension is often treated conservatively or with epidural blood patch. Patients who are resistant to these treatments require accurate imaging localisation of the site of cerebrospinal fluid (CSF) leak for surgical repair. We describe two patients where MRI, CT myelography and MRI gadolinium myelography showed evidence of a large volume of epidural CSF, but failed to identify the pressure site of leak. Subsequently, DynaCT (Siemens, Erlangen, Germany) accurately identified the site with confidence in both cases, confirmed at surgery. This technique of using a flat panel detector‐based, angiographic system to produce high quality, high‐contrast multiplanar CT images for detecting the source of rapid CSF leak is detailed.     

DynaCT在胆道梗阻性疾病的诊断和介入治疗中的应用

目的探讨DynaCT在胆道梗阻性疾病的诊断和介入治疗中的作用。材料和方法对2011年9月至2013年1月共37例胆道梗阻性疾病的患者进行DynaCT检查,获取普通软组织CT图象及三维重建图像。其中男25例,女12例,年龄38～79岁,平均58.5岁。术前扫描进一步明确胆道梗阻的性质、部位及胆管扩张情况,设计预穿刺路径;成功穿刺进入胆管后注入造影剂并行DynaCT扫描显示胆道情况,进一步明确诊断及调整穿刺方向;术后常规扫描评价介入治疗效果。结果 37例患者均成功完成介入治疗,检查中29例造影图像清晰,诊断及引导介入治疗价值大。8例中患者检查图像欠清晰,病变与周围组织密度相差太小3例,病人屏气不好等造成移动伪影3例,造影剂的高密度伪影2例。结论 DynaCT可以一次曝光而获得各种需求图像,可任意角度观察胆管及病变的三维关系,为胆道梗阻患者的诊断与介入治疗提供可靠依据。     

探讨DynaCT在腰椎间盘突出臭氧治疗中应用

目的探讨基于平板数字减影血管造影(DSA)的DynaCT功能在腰椎间盘突出臭氧注射治疗中的应用。方法 40例腰椎间盘突出患者,其中男性26例,女性14例;年龄24～74岁,平均年龄45.3岁。病程3个月～19年,经CT或MRI检查证实为腰椎间盘突出,病变椎间盘主要分布在腰椎第4～5节(L4～5)和腰椎第5节～骶椎第1节(L5~S1)。行DSA腰椎间盘臭氧注射治疗,利用DynaCT对椎间盘在穿刺前后和臭氧注射拔针后进行DynaCT成像。结果穿刺前后DynaCT提供的类CT图像可定位、监测穿刺,病例穿刺成功率为100%。臭氧注入完毕后DynaCT扫描可观察椎间盘内气体分布情况,还可见弥散到椎体前后或肌肉间隙内的气体,40例患者38例为有效或显效,只有2例气体分布不明显的患者治疗效果为无效。结论 DynaCT的使用保障了腰椎间盘突出臭氧治疗的成功率和穿刺中的安全性,臭氧注入完毕后提供的图像为临床评估腰椎间盘突出臭氧治疗效果提供重要依据。     

PCXMC软件估算DynaCT患者辐射剂量方法探究及体模验证

目的:探究使用计算机软件测量DynaCT系统诊疗中患者的辐射剂量.方法:根据DynaCT系统C臂旋转采集数据特点,使用现有计算机软件PCXMC模拟计算患者有效剂量,并采用人体标准体模热释光剂量计实验方法对PCXMC软件模拟结果进行统计学方法验证.结果:PCXMC模拟方法测量患者有效剂量结果——头部0.63 mSv,胸部5.38 mSv,腹部6.97 mSv;体模实验法结果——头部0.85 mSv,胸部6.01 mSv,腹部7.04 mSv.2种方法测量器官吸收剂量统计学分析结果P值均大于0.05.结论:2种方法测量DynaCT患者有效剂量不存在统计学差异,可以根据临床实际条件使用PCXMC软件方便地测量DynaCT诊疗中患者的有效剂量.     

3D iGuide穿刺技术在DynaCT引导射频消融治疗大肝癌中的应用

目的：评价3D iGuide穿刺技术在DynaCT引导射频消融（RFA）治疗大肝癌中的可行性及安全性。 方法：选取2016年9-12月在解放军总医院介入放射科住院治疗的孤立性大肝癌患者19例,行DynaCT扫描并选择3D iGuide技术引导射频针穿刺后实施RFA术,评价术后的技术成功率、术中及术后并发症、治疗效果。 结果：19例患者全部操作成功,技术成功率为100%,术中及术后并发症以疼痛为主,并未出现严重并发症;术后1个月影像学复查评估治疗效果,完全缓解（CR）17例、部分缓解（PR）2例。 结论：3D iGuide穿刺技术在DynaCT引导射频消融治疗大肝癌中安全、有效且操作简便,具有极强的可行性,为RFA治疗肝癌提供新的引导方法。     

应用DynaCT技术进行植入支架的不良事件管理

本文介绍了基于医学信息系统，应用DynaCT血管介入三维成像技术及条形码自动识别技术，开发出的一套适用于高值耗材（支架）不良事件管理的图文报告系统。该系统将较大地提高血管介入的治疗效果，同时能够为有关部门制定与支架不良事件相关的政策法规提供临床工程技术上的支持，有效地减少不良事件的发生。     

DynaCT在经皮椎体成形术治疗椎体转移性肿瘤中的应用价值

目的:探讨DynaCT在经皮穿刺椎体成形术治疗椎体转移性肿瘤中的应用价值.方法:2006年12月～2008年1月共收治伴有不同程度腰背部疼痛的椎体转移性肿瘤患者12例,年龄42～77岁,平均54.7岁.病变椎体共计14个,其中胸椎5个,腰椎9个,CT提示均有溶骨性破坏.均行经皮椎体成形术治疗,术前采用DynaCT技术成像观察椎体骨皮质连续性并和螺旋CT扫描比较,术中采用DynaCT技术成像帮助引导进针,术后根据WHO标准观察镇痛效果,分别使用DynaCT和螺旋CT观察骨水泥渗漏情况,并进行比较.结果:术前DynaCT和螺旋CT扫描显示骨皮质完整情况完全一致,共9个椎体10处骨皮质不连续,其中9处为骨皮质破坏、1处为粗大引流静脉.14个椎体中,8个行单侧椎弓根穿刺注射,6个行双侧椎弓根穿刺注射,均穿刺成功.每个椎体骨水泥注射量2.0～6.0ml,平均3.6ml.术后8例患者疼痛完全缓解(CR),4例部分缓解(PR),有效率100%.DynaCT和螺旋CT重建图像显示的骨水泥渗漏情况完全一致,14个椎体中10个出现骨水泥渗漏,其中3个渗漏至椎旁软组织,4个渗漏入椎旁静脉丛,1个渗漏至椎间隙,1个渗漏入椎管,1个同时渗漏至椎旁静脉丛和椎间隙,渗漏率71.4%,但无1例出现相关症状.10处骨皮质不连续中6处出现骨水泥渗漏.结论:应用DynaCT引导可以确保穿刺准确性,观察骨皮质连续性和骨水泥渗漏的作用和螺旋CT相同.     

Intraoperative DynaCT Detection and Immediate Correction of a Type 1a Endoleak Following Endovascular Repair of Abdominal Aortic Aneurysm

Reintervention following endovascular aneurysm repair (EVAR) is required in up to 10% of patients at 30 days and is associated with a demonstrable risk of increased mortality. Completion angiography cannot detect all graft-related anomalies and computed tomographic angiography is therefore mandatory to ensure clinical success. Intraoperative angiographic computed tomography (DynaCT; Siemens, Germany) utilizes cone beam reconstruction software and flat-panel detectors to generate CT-like images from rotational angiographic acquisitions. We report the intraoperative use of this novel technology in detecting and immediately treating a proximal anterior type Ia endoleak, following an endovascular abdominal aortic repair, which was not seen on completion angiography. Immediate evaluation of cross-sectional imaging following endograft deployment may allow for on-table correction of clinically significant stent-related complications. This should both improve technical success and minimize the need for early secondary intervention following EVAR.