The application of 3D fusion of DSA and MRI in anterior communicating artery aneurysm clipping

Objective To investigate the 3D fusion technique of DSA and MRI and its application value in making surgical plan and simulating operative process for anterior communicating artery (ACoA) aneurysm clipping. Methods From September 2016 to May 2019, aneurysm clipping was performed on 30 patients with unruptured ACoA aneurysm. Infusions of DSA and MRI before surgery with 3D ⁃ Slicer software were performed to reconstruct the brain tissue, optic nerve and internal carotid artery (ICA) model. Using 3D fusion model to make surgical plan and simulate operative process. Comparing 3D fusion model with golden standard, which refers to the surgeon's judgement during surgery, then calculated sensitivity, specificity, false negative rate and false positive rate of rectus gyrus resection, dominance of ACA A1 segment and artery adhesion to the aneurysm. Results 3D fusion of DSA and MRI in 30 patients with ACoA aneurysm were performed. Statistical analysis showed the sensitivity of rectus gyrus resection, the dominance of ACA A1 segment and artery adhesion to the aneurysm were 100% (23/23), 75% (21/28) and 81.82% (18/22), specificity were 42.86% (3/7), 100% (2/2) and 62.50% (5/8), false negative rate were 0 (0/23), 25% (7/28) and 18.18% (4/22), and false positive rate were 57.14% (4/7), 0 (0/2) and 37.50% (3/8). The consistency (κ value) were 0.535 (P = 0.001), 0.504 (P = 0.000) and 0.426 (P = 0.010). Conclusions Using 3D ⁃ Slicer software to realize 3D fusion of DSA and MRI is an image post ⁃ processing technology, which integrates brain tissues, optic nerve and ICA, has a high application value for preoperative plan and surgical training of ACoA aneurysm clipping for younger surgeons. DOI：10.3969/j.issn.1672⁃6731.2020.04.014