IMAGE GUIDED ENDOVASCULAR EMBOLIZATION OF CRANIAL TUMORS

这项建议的目的是开发更快、更安全的方法 术中跟踪血管内栓塞术治疗颅脑肿瘤 并显示导管内的三维(3D)、树状结构 病人的血管系统图。 脑血管系统的血管内手术是困难的。 术中，干预者将他的导管穿过 复杂血管树，仅由X射线血管造影术(血管造影术)引导。 通过导管注入一阵阵造影剂，突出 在投影图上，维管束树的局部区域。无3D信息 是可用的。相反，临床医生只使用2D投影、监视器 导管几乎不间断地向前推进，并经常改变 在尝试可视化3D解剖时的视角。程序是 因此很长，需要多次血管造影，通常结果是 在一小时或更长时间内对患者进行辐射照射。 这项建议旨在降低程序的难度和 通过允许患者接受巨大的辐射暴露 干预者解释每一个2D，术中血管造影 一个3D环境。 具体目标有三个： A)创建每个患者的血管解剖的3D树状地图。 该映射可以单独从分段的MRA数据创建，或者可以包括 术前血管造影术重建提供更多细节 将数据转换为3D格式。 B)创造一个术前计划环境，在这个环境中，临床医生 可以查看来自任何一个血管系统的基于树的描述 交互选择的视角以及与目标的关系 肿瘤。可以选择并保存一个或多个最佳导管路径 以备以后手术中使用。该程序将在标准硬件上运行 并且在通用操作系统下，允许研究血管系统 在现成的计算机上或在家里。 C)将3D血管图与每个术中血管照片配准， 允许干预主义者在3D中可视化 导管位于正确的子树内。肿瘤的位置和 预先选择的最佳导管路径也将在3D中显示。每个人 因此，2D血管造影术可以在其3D上下文中进行解释， 手术的难度，所需的血管造影术数量，以及 患者的辐射暴露和对比负荷。 我们纳入了一项前瞻性、随机、对照的临床试验 我们的方法在减少辐射暴露方面的有效性 并在提供更有效的栓塞术方面发挥作用。 待开发的方法立即适用于肿瘤 栓塞术和化疗在体内的任何地方。他们是 也适用于数千种其他血管内手术 每年演出一次。

The purpose of this proposal is to develop faster, safer methods of endovascular embolization of cranial tumors by intraoperative tracking and display of the catheter within a three-dimensional (3D), tree-based map of the patient's vasculature. Endovascular surgery of the cranial vasculature is difficult. Intraoperatively, the interventionalist threads his catheter through a complex vascular tree, guided only by x-ray angiography (angiography). Puffs of contrast medium are injected through the catheter, highlighting on projection view a local region of a vascular tree. No 3D information is available. Instead, the clinician uses only 2D projections, monitors catheter advancement almost continuously, and frequently changes the angle of view in the attempt to visualize 3D anatomy. The procedure is therefore lengthy, requires multiple angiograms, and commonly results in an hour or more of radiation exposure to the patient. This proposal aims to reduce the difficulty of the procedure and the immense radiation exposure delivered to the patient by allowing the interventionalist to interpret each 2D, intraoperative angiogram within a 3D context. There are 3 specific aims: a) To create a 3D, tree-based map of each patient's vascular anatomy. This map may be created from segmented MRA data alone or may include the additional detail provided by reconstructing preoperative angiographic data into 3D. b) To create a preoperative planning environment, in which the clinician may view a tree-based description of the vasculature from any interactively selected angle of view and in relationship to the target tumor. One or more optimal catheter pathways may be selected and saved for later intraoperative use. The program will run on standard hardware and under a common operating system, allowing study of the vasculature on readily available computers or at home. c) To register the 3D vascular map with each intraoperative angiogram, allowing the interventionalist to visualize, in 3D, t he position of the catheter within the proper subtree. Both the location of the tumor and a preselected optimal catheter pathway will also be shown in 3D. Each 2D angiogram can thus be interpreted within its 3D context, diminishing the difficulty of the procedure, the number of angiograms required, and the patient's radiation exposure and contrast load. We include a prospective, randomized, controlled clinical trial of the efficacy of our methods in both reducing radiation exposure to the patient and in providing more effective embolization. The methods to be developed are immediately applicable to tumor embolization and chemotherapy delivery anywhere in the body. They are also applicable to many thousands of other endovascular procedures preformed each year.