The use of 3D computer graphics in the diagnosis and treatment of spinal vascular malformations
The use of 3D computer graphics in the diagnosis and treatment of spinal vascular malformations
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DOI：
10.3171/2011.8.spine11155
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发表时间：
2011-12-01
影响因子：
2.8
通讯作者：
Saito, Nobuhito
中科院分区：
文献类型：
--
作者：
Takai, Keisuke;Kin, Taichi;Saito, Nobuhito
Object.数字减影（DS）血管造影是诊断脊髓血管畸形的金标准。最近，多排螺旋CT和对比增强MR血管造影已被引入作为DS血管造影前的筛选检查。然而，这些方法并不总是确定动静脉分流的准确位置，因为得到的图像缺乏关于脊髓或硬脑膜的信息。2009年4月至2010年12月，13名患者在作者所在的大学医院接受了脊髓血管畸形的影像学评价。该组包括8例硬脊膜动静脉瘘（AVF）患者，3例髓周AVF患者和2例髓内动静脉畸形患者。利用这些患者的数据，作者尝试在融合3D旋转血管造影和脊髓造影后CT的基础上开发3D计算机图形（CG）。他们随后验证了这种成像方法的准确性。这13例患者中有10例接受了病变的手术治疗（11个AVF），对于这11个病变，作者比较了使用3D CO和使用传统DS血管造影获得的诊断。在所有13例病例中，利用患者的实际数据成功地开发了脊柱病变的3D CO图像。11例AVF中，4例（36%）通过DS血管造影正确识别，10例（91%）通过3D CO正确识别。脊髓AVF的3D CO结果与手术结果吻合良好，3D CO在预测AVF位置方面明显优于传统DS血管造影（p = 0.024，Fisher精确检验）。据作者所知，这是第一个报告的病例系列，其中脊髓血管畸形的3D CO用于提供脊髓血管系统、脊髓、硬脑膜和骨的同步立体可视化。3D CO方法为这些病变的诊断和治疗提供了精确的视觉图像。(DOI：10.3171/2011.8.SPINE11155）
Object. Digital subtraction (DS) angiography is the gold standard for diagnosing spinal vascular malformations. Recently, multidetector-row spiral CT and contrast-enhanced MR angiography have been introduced as screening examinations before DS angiography. These methods, however, do not always determine the accurate location of an arteriovenous shunt because the resulting images lack information about the spinal cord or the dura mater.Methods. Between April 2009 and December 2010, 13 patients underwent imaging evaluations for spinal vascular malformations at the authors' university hospital. This group included 8 patients with spinal dural arteriovenous fistulas (AVFs), 3 with perimedullary AVFs, and 2 with intramedullary arteriovenous malformations. Using data from these patients, the authors attempted to develop 3D computer graphics (CG) based upon the fusion of 3D rotational angiography and postmyelographic CT. They subsequently verified the accuracy of this imaging method. Ten of these 13 patients underwent surgical treatment for their lesions (11 AVFs), and for these 11 lesions the authors compared the diagnoses obtained using 3D CO with those obtained using conventional DS angiography.Results. In all 13 cases, 3D CO images of the spinal lesions were successfully developed using the patients' actual data. Four (36%) of 11 AVFs were correctly identified using DS angiography, whereas 10(91%) were correctly identified using 3D CO. Results from 3D CO of spinal AVFs corresponded well with operative findings, and 3D CO was significantly better than conventional DS angiography at predicting AVF location (p = 0.024, Fisher exact test).Conclusions. To the authors' knowledge, this is the first reported case series in which 3D CO of spinal vascular malformations was used to provide simultaneous, stereoscopic visualization of the spinal vascular system, spinal cord, dura mater, and bone. The 3D CO method provides precise visual images for the diagnosis and treatment of these lesions. (DOI: 10.3171/2011.8.SPINE11155)