4D DICOM透视虚拟技术辅助颈内动脉起始处重度狭窄支架植入的疗效研究

目的研究4D医学数字成像和通信（DICOM）透视虚拟技术辅助颈内动脉起始处重度狭窄支架植入治疗的临床应用价值。 方法回顾性分析大连大学附属中山医院神经外科自2016年10月至2017年10月收治的40例颈内动脉起始部重度狭窄患者的临床资料。将其CTA、MRA等DICOM影像原始数据上传，应用4D DICOM透视虚拟技术合成虚拟现实影像，指导手术操作的路径。运用4D血管内窥影像术前模拟手术入路，测量观察血管内管径大小，观察血管狭窄处斑块大小及与其在血管腔内的空间结构。通过对手术时间、手术失败率等的比较，分析运用4D DICOM透视虚拟技术指导介入治疗前后的不同。 结果运用4D DICOM透视虚拟技术中的4D血管内窥影像辅助支架植入的患者手术过程顺利，均成功植入支架，均未发生术中的不良血管事件。术后1年复查CTA及运用血管内镜技术评估预后都良好，支架位置准确，与血管壁贴合良好，无再次血栓形成。 结论应用4D DICOM透视虚拟技术能快速、直观、全面的整合多个影像学数据，提供血管解剖学和管腔内情况，有助于血管狭窄处支架植入，减少手术时间，降低术后血管并发症的出现，为术前制定和优化手术方案提供了帮助，并提高了手术的安全性和成功率。

Study on the application of 4D DICOM perspective virtual reality technique in the treatment of severe stenosis of carotid artery stenosis at the beginning of internal carotid artery

ObjectiveTo study the clinical value of 4D digital imaging and communication in medicine (DICOM) perspective virtual technology in stent placement for severe stenosis of internal carotid artery. MethodsThe clinical data of 40 cases of severe stenosis of the initial internal carotid artery in the Department of Neurosurgery, Zhongshan Hospital Affiliated to Dalian University from October 2016 to October 2017 were analyzed retrospectively. By collecting the original data of the CTA, MRA and other DICOM images of the patients who with the stenosis in the internal carotid artery, the CTA, MRA and other DICOM images were uploaded. The virtual reality images were synthesized by 4D DICOM perspective, and the path of operation was guided. The size of the intravascular diameter was measured by 4D endoscopic surgery, and the size of the plaque and its spatial structure in the vascular endovascular were observed. Through the comparison of operative time and operative failure rate, we analyzed the difference of virtual technology guided by 4D DICOM before and after interventional therapy. ResultsThe operation process of the patients with 4D vascular endoscopy assisted stent implantation in the virtual technology of 4D DICOM perspective technoly was successful, and all the stents were successfully implanted, and no adverse vascular events occurred during the operation. 1 years after operation, CTA and vascular endoscopy were used to evaluate the prognosis. The position of the stent was accurate, and the blood vessel wall was well fitted with no thrombosis. ConclusionThe application of 4D DICOM perspective virtual technology can integrate multiple imaging data quickly, intuitively and comprehensively, provide vascular anatomy and intraluminal conditions, which can help the stent implantation in the vascular stenosis, reduce the operation time and postoperative vascular complications. It is helpful for the formulation and optimization of surgical procedures before operation, and improves the safety and success rate of operation.