三维增强核磁共振血管造影在内脏动脉瘤诊治中的应用

Clinical value of three-dimensional contrast-enhanced MR angiography in the diagnosis of visceral artery aneurysms

目的探讨三维增强核磁共振血管造影在内脏动脉瘤诊治中的临床价值。方法对43例内脏动脉瘤患者行三维增强MR血管造影检查，19例同期行数字减影血管造影（digital subtraction angiography，DSA）。三维增强MR血管造影用屏气超快速三维梯度回波序列，图像减影后进行三维重建。结果43例共50个内脏动脉瘤，涉及脾动脉32个（其中5例脾动脉异位起源于肠系膜上动脉），占64％；肠系膜上动脉7个（14％），腹腔动脉干5个（1例为腹腔系膜干），肾动脉4个，肝动脉2个。三维增强MR血管造影能清楚显示动脉瘤部位、大小、形态，并在立体直观显示动脉瘤及其与周围血管脏器关系方面优于DSA。43例中，行栓塞治疗15例，手术9例，保守观察19例。结论三维增强MR血管造影能无创、准确诊断内脏动脉瘤，所提供的三维解剖细节有助于临床治疗方案的制定，可作为内脏动脉瘤的首选检查方法。

Objective To evaluate the clinical value of three-dimensional contrast-enhanced MR angiography （3D CE-MRA） in the diagnosis and treatment of visceral artery aneurysms. Methods Fortythree patients with visceral artery aneurysms underwent 3D CE-MRA sequence after injection of 0.2 mmol Gd-DTPA per kg. bw. The source images were subtracted and transferred to computer workstation subsequently post-procession. Digital subtraction angiography （DSA） was performed in 19 patients simultaneously for the purpose of control study. Results There were 43 cases with 50 visceral artery aneurysms. The arteries involved were 32 splenic artery aneurysms accounting for 64% including 5 anomalously arising from superior mesenteric artery; 7 of superior mesenteric （ 14% ） ; 4 celiac （ 1 from celiomesenteric trunk） , 5 of renal and 2 of hepatic. 3D CE-MRA clearly demonstrated aneurysm＇s location, size, morphology, and was superior to DSA in three-dimensional display of aneurysm and its relationship with surrounding vessels and involved organs. Endovaseular treatment was performed in 15 patients, surgical treatment in 9, and conservative therapy only in 19. Conclusion 3D CE-MRA is a noninvasive and accurate technique for the diagnosis of visceral artery aneurysms. Its three-dimensional anatomic information is very helpful for treatment planning. 3D CE-MRA could be used as a test of choice in the evaluation of visceral artery aneurysms.