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In pre-print: Diagnostic value of three-dimensional reconstruction with multislice spiral CT angiography in patients with cerebrovascular disease.

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Authors:

R.Sui1, H-T. Wang1, X-Y. Yu2, X-Q. Zhang3, X-L. Wei1, D-Y. Xin1 and D-W. Han4

 AFFILIATIONS:

1 Department of Radiology, Linyi Central Hospital, Linyi, Shandong Province, China
2 Department of Radiology, Linyi Traditional Chinese Medicine Hospital, Linyi, Shandong Province, China
3 Department of Orthopedics, YiShui People’s Hospital, Linyi, Shandong Province, China
4Department of Radiology, Huangdao District Central Hospital of Qingdao, Qingdao, Shandong Province, China

 

To the Editor,

At present, cerebrovascular disease is one of the most common diseases in the elderly (1-3). Due to the high incidence, disability and mortality, it seriously endangers the healthy life of elderly patients. Conventional CT angiography (CTA) is mainly used in clinical practice for patients with cerebrovascular disease. However, because the elderly are prone to vascular rupture caused by weak vascular elasticity, the injection rate is reduced during the contrast injection process, resulting in serious bone residual, uneven and discontinuous vascular wall after bone removal on CTA images (4-6). With the continuous development of science and technology, 3D reconstruction with multislice spiral CT angiography (MSCTA) has been gradually applied to clinical treatment  (7). In order to explore the diagnostic value of 3D reconstruction with MSCTA in patients with cerebrovascular disease, 60 patients in our hospital from June 2018 to April 2020 were selected, aiming to provide a reference basis for the clinical diagnosis by 3D Reconstruction with MSCTA.

MATERIALS AND METHODS

Sixty patients with cerebrovascular disease who received 3D Reconstruction with MSCTA between June 2018 and April 2020 in our hospital were selected as the study subjects, as shown in Table I.

Table I.  Analysis of general clinical data of the patients in two groups

Factors Indexesn=60
Gender (case) Male 32
Female 28
Average age (years) 61.08±8.42
Clinical manifestation Language barrier 10
Headache 22
Nausea and vomiting 20
Other 8
Multi-slice spiral CT plain scan Cerebral infarction 15
Simple intracerebral hematoma 17
Subarachnoid hemorrhage 14
Malformed vessel mass 6
No abnormality 8

MSCTA

All 60 patients received MSCTA with a Philips instrument, and relevant parameters were: 250 mA tube current, 120 kv tube voltage, 512×512 matrix, 0.9 mm slice thickness; 100 ml (280 mg/ml) iohexol was bolus injected via the elbow vein at a rate of 3.0ml/s-3.5ml/s with a trigger time of 10-20s. Then bolus tracking technology was used. The aortic arch was the main observation area and the threshold was 100Hu. Scanning site: The baseline was the auditory canthus line, scan starting from the base to the top of the skull. Before scanning, the patient’s head was fixed and the patient was not allowed to cough or swallow.

 3D Reconstruction

Sixty patients received 3D reconstruction through maximum intensity projection (MIP), volume rendering (VR), and surface shaded display  (SSD).

Statistical analysis

In this study, the research data was processed and analyzed by the data software SPSS20.0. The measurement data were measured by t-test, expressed by (x̄±s), and the count data were tested by c2, expressed by  n(%). The difference was statistically significant when p < 0.05.

 

 

DISCUSSION

With the continuous development of science and technology, CT angiography technology continues to develop and has now been widely used in the diagnosis and treatment of cerebrovascular disease (8-10). The majority of the patients are the elderly whose blood vessel elasticity is weak, which will lead to the rupture of the vessel wall. Therefore, in order to avoid leakage of contrast agents, the injection rate is usually reduced during the injection process (11-12). The reduction of the rate leads to serious bone residual, uneven and discontinuous vascular wall, and paracranial vascular artifacts after bone removal on CTA images, which is not conducive to clinical diagnosis.

 

Experience of application of 3D reconstruction with MSCTA

3D reconstruction with MSCTA is the latest diagnostic method in cerebrovascular disease at present. According to He  et al. (13) and this study, it can be concluded that four points should be noted when implementing 3D reconstruction with MSCTA in elderly patients with cerebrovascular disease (1). The patient’s head should be fixed before testing to avoid movement during the testing process, which is the key to success of 3D reconstruction with MSCTA (2). Elderly patients with cerebrovascular disease are prone to vascular wall rupture, so high injection rate of contrast agents will cause leakage during the detection process. Therefore, the injection rate should be paid attention to during the injection of contrast agents. The ages of the study subjects were (61.08±8.42) years and the injection rate was controlled at 3.0ml/s-3.5 ml/s. No injection leakage occurred, and the clinical image quality was satisfactory (3). The peak time of contrast agent varies from patient to patient, as does the trigger time. In this study, trigger time was set to 10-20s. Bolus tracking technology was used and solved the problem that the peak time of contrast agent was different for each patient (4). Cranial artifacts affect the smoothness and continuity of blood vessels, resulting in serrated artifacts which are more serious in the intracranial segments of basal and vertebral arteries. Therefore, the original image of proper thickness should be used in 3D reconstruction with MSCTA, which has a positive effect on reducing serrated artifacts. In this study, 0.9 mm slice thickness was selected to subtract under the premise of ensuring image resolution, which achieved good effects.

 

Clinical diagnostic significance of 3D reconstruction with MSCTA

According to the research results of Cejna (14) et al., it can be seen that 3D reconstruction with MSCTA has the advantages of thinner scanning layer, high spatial resolution, all-round scanning and no damage. In this study, through 3D reconstruction with MSCTA in 60 patients,  it was found that images of all patients were clearly structured, which was consistent with the conclusion of Lu et al. (15). The display rate of 3D reconstruction with MSCTA was 100%  in the diagnosis of cerebrovascular disease. 3D reconstruction with MSCTA is a maximum intensity projection method, which plays an active role in the diagnosis of cerebrovascular disease, especially as the volume rendering technique can adjust the brightness and transparency through different thresholds. The results of this study showed that among the 60 patients, there were 21 cases of aneurysm, 8 cases of cerebral stenosis, 18 cases of arteriovenous malformation and 13 cases of embryonic posterior cerebral hemangioma, indicating that 3D reconstruction with MSCTA can scan all the data and provide accurate 3D images for clinical diagnosis.

In this study, through 3D reconstruction with MSCTA in 60 patients,  it was found that images of all patients were clearly structured and the specific size, location and shape of the aneurysms could be clearly diagnosed. Twenty-one cases of aneurysm, with lesion of 3.39mm~22.78mm in diameter, comprised 2 patients with A2 segment of anterior cerebral artery, 12 patients with C2 segment venous artery, 2 patients with basal artery trunk, 3 patients with posterior communicating artery and 2 patients with anterior communicating artery according to the lesion locations. Eighteen cases of arteriovenous malformation included 7 patients with right parietal lobe and 11 patients with right cerebellar hemisphere. Eight cases of cerebral stenosis included 3 patients with P1 segment stenosis of posterior cerebral artery and 5 patients with  vertebral artery V5 stenosis. Thirteen cases of embryonic posterior cerebral hemangioma included 2 patients whose position of segment C2 rises, 3 patients with vascular variations and 8 patients with posterior communicating artery cones. The research results proved that 3D reconstruction with MSCTA can comprehensively detect the patients with cerebrovascular disease, and the location and type of lesions can be accurately grasped and displayed in the 3D images, thus providing important and accurate reference data for clinical diagnosis and treatment.

In conclusion, the application of 3D reconstruction technology with MSCTA has a high diagnostic rate in the clinical diagnosis of patients with cerebrovascular disease, therefore, it is worthy of popularization and application in the clinical diagnosis of cerebrovascular disease.

 

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