三维时间分辨对比动态增强MR血管成像的临床应用

Clinical application of three-dimensional MR angiography using time-resolved imaging of contrast kinetics

目的：探讨三维时间分辨对比动态增强MR血管成像（three dimensional time-resolved imaging of contrast kinetics，MRA 3D-TRICKS）在临床中的应用价值。材料与方法搜集60例行TRICKS检查的患者，于TRICKS扫描前采集感兴趣区蒙片，团注对比剂后采集15～20时相。结果60例患者均完成TRICKS检查，图像均达到诊断要求。11例颅内动脉成像显示良好（6例动静脉畸形、2例头皮动脉静脉畸形和3例静脉窦血栓）。5例颈动脉血管成像显示良好（3例颈总动脉分叉处狭窄、1例左侧椎动脉狭窄和1例颈部神经纤维瘤）。10例脊髓血管畸形显示良好。上肢血管成像为5例血管瘤。下肢和足部血管成像22例（10例为动脉静脉瘘、假性动脉瘤1例、3例糖尿病患者下肢血管闭塞和8例为下肢动脉狭窄）。盆腔血管成像7例（2例髂骨骨肉瘤、3例股骨骨肉瘤和2例纤维瘤）。结论 TRICKS能清晰显示多个部位的血管系统，并能从多个角度观察病变血管。TRICKS因其时间分辨率高、诊断准确率高，在血管性病变的无创性诊断中具有重要的作用。

Objective： To investigate the value of MR angiography using time-resolved imaging of contrast kinetics （TRICKS） in clinical practice. Materials and Methods：60 patients performed TRICKS in our hospital were enrolled in this study. Masks were scanned before TRICKS and 15-20 phases were acquired after contrast agent bonus injection. Results：All 60 patients completed TRICKS and images met diagnostic requirements. 11 cases of intracranial angiography had good image quality, including arteriovenous malformation （n=6）, scalp arteriovenous malformation （n=2） and venous sinus thrombosis （n=3）. 5 cases of cervical angiography displayed well including bifurcation of carotid artery stenosis （n=3）, left vertebral artery stenosis （n=1） and neurofibroma （n=1）. 10 cases of spinal vascular malformation showed well on TRCIKS. Upper limbs angiography displayed 5 cases hemangioma. 22 cases of lower limbs and foot angiography showed arteriovenous ifstula （n=10）, pseudoaneurysm （n=1）, lower limbs vascular occlusion in patients with diabetes mellitus （n=3） and lower limbs arteries stenosis （n=8）. 2 cases of iliac osteosarcoma, 3 cases of femur osteosarcoma and 2 cases of ifbroma showed well on pelvic TRICKS （n=7）. Conclusions：TRICKS is able to describe clearly vascular system and demonstrate lesions by many aspects. It plays an important role in the non-invasive diagnosis of vascular diseases, for its high temporal resolution and accuracy.