三维动态增强MRA诊断硬脊膜动静脉瘘的价值分析

The Diagnostic Value Analysis of Three Dimensional Dynamic Contrast Enhanced MR Angiography in Spinal Dural Arteriovenous Fistula

目的探讨三维动态增强磁共振血管成像(3D-DCE-MRA)对硬脊膜动静脉瘘(SDAVF)的诊断价值。资料与方法36例SDAVF患者分别行脊髓3D-DCE-MRA检查及DSA检查,外科手术治疗33例,血管内栓塞治疗3例。对3D-DCE-MRA图像进行分析,以病变的定性诊断,供血动脉、瘘口、引流静脉等的显示情况为观察指标,与DSA及手术结果相对照。结果3D-DCE-MRA对36例SDAVF均做出正确诊断。DSA及手术确诊供血动脉42支,3D-DCE-MRA正确诊断35支,漏诊7支,误诊2支,3D-DCE-MRA诊断供血动脉的敏感性为83.3%;DSA和/或手术证实36例SDAVF共38个瘘口,DSA清晰显示37个,1个未显示;3D-DCE-MRA显示瘘口34个,4个瘘口未显示,3D-DCE-MRA对瘘口显影率为89.5%;3D-DCE-MRA对SDAVF的引流静脉均显示,且对大范围的引流静脉显示优于DSA。结论3D-DCE-MRA对SDAVF能够做出正确的定性诊断,对供血动脉、瘘口、引流静脉等细节信息的显示也有较高的准确性,在一定程度上可替代脊髓DSA或使DSA时节段性动脉的选择更有针对性。

Objective To explore the diagnostic value of three dimensional dynamic contrast-enhanced MR angiography （3D-DCE-MRA） in spinal dural arteriovenous fistula （SDAVF）. Materials and Methods 3D-DCE-MRA was applied in 36 patients with spinal dural arteriovenous fistula using a 3.0T magnet system. Selective spinal digital subtraction angiography（DSA） was performed in all cases . MR and 3D-DCE-MRA follow up were undertaken in 10 patients after the treatments. 3D-DCE-MRA images were analyzed in some aspects, including revealing degree of feeding artery, fistula,and draining vein and compared the results with those of DSA. Results All 36 cases were correctly diagnosed with 3D-DCEMRA. 42 feeding arteries of fistulas were detected by DSA and surgery, and 35 feeding arteries were correctly detected by 3D-DCE-MRA with 7 missed diagnosis and 2 misdiagnosed. The sensitivity of 3D-DCE-MRA for revealling feeding arteries was 83.3%. 38 fistulas were detected by DSA and/or surgery. 37 fistulas were detected by DSA, 34 were visualized clearly and 4 were not visualized by 3D-DCE-MRA The visualization rate of 3D-DCE-MRA is 89.4%. 3D-DCE-MRA could dis- play all the perimedullary draining veins , and superior to DSA for wide-ranging draining veins. Conclusion 3D-DCE- MRA is able to diagnose spinal dural arteriovenous fistula. It can visualize the details of feeding artery, fistula, and draining vein. In some extent it can replace DSA or guide selective catheterization to specific spinal levels. 3D-DCE-MRA is important to be the follow-up method for SDAVF.