摘要
目的 探讨颅内动脉瘤单纯Pipeline栓塞装置(PED)治疗后瘤内血流动力学改变及其与动脉瘤闭塞的相关性.方法 回顾性分析2016年1月至2020年12月单纯使用PED治疗的63例(68个动脉瘤)颅内动脉瘤的临床资料和DSA影像资料.选择动脉瘤瘤腔中心和距离动脉瘤瘤颈近心端2cm处的载瘤动脉(参考点)为感兴趣区,使用基于Python的自研程序对DSA数据进行血管造影参数成像(API)分析,获取时间-密度曲线,计算血液动力学参数及其变化率(△),包括平均通过时间(MTT)、达峰时间(TTP)、峰高(PH)、曲线下面积(AUC)、半峰全宽(FWHM).结果 68个动脉瘤共置入68个PED,术后6个月影像随访显示动脉瘤完全闭塞52个(76.5%),未完全闭塞16个(23.5%).API分析显示,术后参考点FWHM显著延长(P<0.05),动脉瘤内TTP、FWHM和MTT显著延长(P<0.05),动脉瘤内PH显著降低(P<0.05).相比参考点,动脉瘤内术后血流动力学变化更为显著(P<0.05).闭塞动脉瘤术后瘤内TTP、FWHM和MTT显著延长(P<0.05),PH显著降低(P<0.05);而未闭塞动脉瘤内血流动力学参数无显著变化(P>0.05).术后动脉瘤内TTP、FWHM和MTT分别延长了22.8%、36.0%和25.0%,而闭塞动脉瘤内TTP、FWHM和MTT分别延长了43.9%、53.0%和38.3%.ROC曲线分析显示,∆MTT、∆TTP、∆FWHM对术后6个月动脉瘤的闭塞情况具有一定的预测价值,而且联合预测效果更好.结论 颅内动脉瘤单纯PED治疗后闭塞结果和术后瘤内血流的减缓相关.API技术对真实的血流效应有良好的反馈,可以定量表征血流信息变化,可以预测PED治疗后远期动脉瘤的闭塞情况.
Abstract
Objective To investigate the changes of blood flow dynamics in aneurysm sacs of intracranial aneurysms after Pipeline embolization device(PED)treatment alone and its correlation with aneurysm occlusion.Methods The clinical data and DSA imaging data of 63 patients(68 aneurysms)who underwent PED treatment alone from January 2016 to December 2020 were retrospectively collected.The center of aneurysm sac and the point of parent artery at 2 cm proximal to aneurysm neck(reference point)were selected as the regions of interest.A self-developed Python-based program was used to perform angiographic parameter imaging analysis using the DSA data,obtaining the time-density curve to calculate hemodynamic parameters and their rates of change(△),including the mean transit time(MTT),time to peak(TTP),peak high(PH),area under the curve(AUC),and full width at half maximum(FWHM).Results A total of 68 PEDs was uesed in 68 aneurysms,of which 52 aneurysms(76.5%)were completely occluded and 16 aneurysms(23.5%)were not completely occluded at 6 months after treatment.The API analysis showed that the FWHM at the reference point was significantly prolonged(P<0.05),and the hemodynamic parameters in the aneurysm sac,including TTP,FWHM,and MTT,were significantly prolonged(P<0.05)and the PH was significantly lower(P<0.05).Compared with the reference point,the hemodynamic changes in the aneurysm sac after treatment were more significant(P<0.05).The hemodynamic parameters in the aneurysm sacs of completely occluded aneurysms changed significantly after treatment,with TTP,FWHM,and MTT being significantly prolonged(P<0.05)and the PH being significantly lower(P<0.05).However,there were no significant changes in the hemodynamic parameters within the aneurysm sacs of incompletely occluded aneurysms(P>0.05).After surgery,the TTP,FWHM,and MTT within the 68 aneurysms were prolonged by 22.8%,36.0%,and 25.0%,respectively;the TTP,FWHM,and MTT within the 52 completely occluded aneurysms were prolonged by 43.9%,53.0%,and 38.3%,respectively.ROC curve analysis showed that∆MTT,∆TTP,and∆FWHM had certain predictive value for the occlusion of intracranial aneurysms at 6 months after PED treatment alone,and the predicting effect of the combination of thses parameters was better.Conclusions The occlusion of intracranial aneurysms after PED treatment alone are related to the slowdown of blood flow within the aneurysms.The API technology has good feedback on the real blood flow effect and can quantitatively characterize the changes in blood flow information.It can predict the occlusion of intracranial aneurysms after PED treatment alone.
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