三维增强磁共振血管成像用于动脉狭窄性病变血管内介入治疗前的价值

3-D contrast-enhanced MRA before endovascular interventional treatment of arterial stenosis

目的评价并行采集高分辨力3D CE MRA用于诊断各种动脉狭窄性病变和指导血管内介入治疗的价值。方法35例拟行血管腔内介入治疗(经皮血管腔内成形和支架放置)的病人在术前接受并行采集高分辨力3D CE MRA检查。35例中包括肾动脉狭窄10例、移植后肾动脉狭窄1例、颈动脉狭窄12例、髂动脉狭窄11例和股腘动脉狭窄1例。35例共39段动脉接受了治疗。评价各种动脉病变的显示质量,分析和比较3D CEMRA和DSA显示的狭窄程度和长度以及病变段的特征(偏心性狭窄、有无溃疡、有无狭窄后扩张等),判断3DCE MRA用于指导血管腔内介入治疗的价值。结果3D CE MRA能很好显示各种动脉闭塞性病变。3D CEMRA和DSA显示狭窄程度和长度的相关性很好。两者显示狭窄特点的符合率高。3D CE MRA高估3例髂动脉严重狭窄。除这3例外,3D CE MRA均能很好指导血管腔内介入治疗。另外与DSA相比,3D CE MRA能更好地显示髂动脉的闭塞和远端再通血管。结论3D CE MRA能较为准确地显示动脉狭窄的解剖表现从而指导血管腔内介入治疗。

Purpose To evaluate the efficacy of high-resolution 3D contrast-enhanced MRA （3D CE MRA） with parallel imaging technique for the diagnosis of various arterial stenosis and its value for planning endovascular interventional treatment. Methods Thirty-five patients underwent high-resolution 3D CE MRA before attempted endovascular interventional treatment （percutaneous transluminal angioplasty and/or stent placement）. The patients recruited were with clinically documented renal artery stenosis （n = 10）, renal transplant artery stenosis （n = 1 ）, carotid artery stsnosis （n = 12）, iliac artery stenosis （n = 11） and femoro-popliteal artery stenosis（n = 1 ）. A total of 39 arterial segments were treated. The depiction of various arterial stenosis was evaluated. The degree of stenosis and length of abnormal segment were compared and analyzed between 3D CE MRA and DSA. The agreement in depicting the lesion characteristics （ulceration, eccentricity, poststenotic dilatation, etc） between the two techniques was also reviewed. The overall value of 3D CE MRA in planning the interventional treatment was determined. Results The quality of 3D CE MRA in demonstration of various arterial stenosis was judged excellent or good. Strong correlation was noted between 3D CE MRA and DSA regarding severity and length of stenosis （r = 0.98, P 〈 0.00 01）. The agreement between the two techniques in identification of lesion characteristics was good （96.8% - 100%）. 3D CE MRA overestimated 3 severe iliac artery stenoses. Except in these 3 segments, the value of 3D CE MRA study in planning the intervention was judged high. 3D CE MRA was found better than DSA in revealing the distal reconstitution and occluded segment in cases of iliac artery stenosis. Conclusions 3D CE MRA is accurate in demonstrating relevant anatomy necessary to plan endovascular interventional treatment for patients with arterial occlusive disease.