3.0T三维时间飞越法MRA对颅内动脉瘤的诊断价值

The diagnostic value of 3.0T three-dimensional time of flight magnetic resonance angiography in intracranial aneurysms

目的:评价3.0T三维时间飞越法磁共振血管摄影术(MRA,3D-TOFMRA)对颅内动脉瘤的诊断价值。方法:对27例高度怀疑有颅内动脉瘤的病人行3D-TOFMRA检查,随后行数控减影血管造影术(DSA)造影及可行的血管内栓塞治疗,工作站上三维重建,比较3D-TOFMRA及常规DSA在显示动脉瘤、瘤颈及与载瘤动脉关系上的优劣,及对血管内栓塞治疗的价值。结果:27例脑动脉瘤患者共20个动脉瘤,3D-TOFMRA对动脉瘤的敏感度为95%,特异度80%,准确度90%。3D-TOFMRA对动脉瘤细节及瘤颈的显示明显优于常规DSA,尤其是颈内动脉海绵窦部及椎动脉近小脑后下动脉的动脉瘤,可指导DSA显示动脉瘤方向及预先制定治疗方案。但对周边部及动脉分叉处小动脉瘤的诊断应谨慎。结论:3D-TOFMRA能无创有效地诊断颅内动脉瘤,所提供的三维信息对治疗方案的制定具有极大帮助。当诊断有怀疑时,应结合DSA检查。

Objective：To evaluate the diagnostic value of 3.0T three-dimensional time of flight magnetic resonance angiography （3D-TOF MRA） in intraeranial aneurysms.Methods：3D-TOF MRA was performed in 27 patients highly suspected with intracranial aneurysms.Then conventionl digital subtraction angiography （DSA） and feasible endovascular treatment were performed simultaneously.The source images were subtracted from mask images and transferred to computer workstation.All images were subsequently post-processed using three-dimensional reconstruction.3D-TOF MRA images and DSA images were compared for demonstration of the aneurysm,its neck and relationship with parent artery and the usefulness for endovascular treatment evaluation.Results：There were 27 cases with 20 intracranial aneurysms.The sensitivity,specititity and accuracy of 3D-TOF MRA were 95%,80%,90%,respectively.Aneurysms and its neck depiction at 3D-TOF MRA were significantly better than those at DSA,especially for aneurysms adjacent to the cavernous sinus and near the PICA of the vertebral artery.3D-TOF MRA could guide neurosurgeons to the desired DSA projection,and help them to make plan for interventional or surgical treatment in advance.But the diagnosis should be very carefully made for small aneurysms located in the periphery and the arterial bifurcation.Conclution：3D-TOF MRA is a fast,noninvasive and efficient technique for diagnosing intracranial aneurysms.Its three dimensional information is help for DSA demonstration and treatment planning.Any uncertain diagnosis requires DSA confirmation.