颅内动脉瘤的比较影像学研究

目的：比较分析DSA、3D TOF MRA及CT对颅内动脉瘤的诊断价值。方法：30例颅内动脉瘤均经血管造影和手术征实，所有病例均先后作CT、3D TOF MRA及DSA检查，对其影像学特征进行比较研究。结果：DSA显示全部瘤体，呈囊状、梭形局部突出影；3D TOF MRA显示28个动脉瘤(2个假阳性)，4个未显示，其显示动脉瘤的敏感性为86．7％，假阳性为6．7％。CT显示瘤体及蛛网膜下腔出血提示动脉瘤者15例，占50％；无异常者8例，占26．7％。结论：DSA仍然是诊断颅内动脉瘤的金标准‘3D TOF MRA虽然是显示颅内动脉瘤的敏感方法之一，但对确定治疗方案价值低于DSA；CT敏感性较差，但可通过显示其间接征象提示动脉瘤。     

颅内巨大动脉瘤的MRI影像学分析

目的：评价MRI对颅内巨大动脉瘤的诊断价值。方法：搜集经血管造影或手术证实的21例颅内巨大动脉瘤,MR扫描使用3.0TMR系统,FSE和SE脉冲序列。结果：动脉瘤大小为2.5～8.1cm,位于鞍旁10例、鞍上4例、侧裂池3例、后颅窝3例、额顶部1例。载瘤动脉来源于颈内动脉11例、大脑前动脉A1与A2段交界处3例、大脑中动脉M1与M2交界处3例、椎基底动脉3例、大脑前动脉A3段1例。11例伴不同程度的血栓表现为瘤体周边不均匀混杂信号。MRI对伴有血栓形成的动脉瘤实际瘤体大小的显示均优于MRA和DSA。结论：MRI在颅内巨大动脉瘤诊断中对瘤体大小、瘤体内部有无血栓形成及瘤体周围的改变明显优于MRA和DSA。临床疑似颅内动脉瘤时不应只进行MRA或DSA检查。     

MRI及三维增强MR血管成像对鞍区动脉瘤的诊断价值

目的 评价MRI及三维增强MR血管成像(3D CE MRA)对鞍区动脉瘤的诊断价值.方法 18例鞍区动脉瘤患者行头颅MRI检查,其中14例行头颅MRI及3D CE MRA检查,1例行DSA检查.3D CE MRA原始图像减影后至工作站用实时三维容积显示技术进行三维重组.结果 18例MRI检查均诊断为鞍区动脉瘤.14例行3D CE MRA检查明确显示动脉瘤的位置、形态、大小,位于颈内动脉虹吸段共12例,左侧6例,右侧6例,位于颈内动脉颅内段2例,左侧1例,右侧1例.结论 MRI及3D CE MRA对鞍区动脉瘤能无创性准确定位定性,基本满足临床需求,为临床治疗提供更准确的依据,可作为首选的影像检查方法.     

下肢动脉瘤的MRI诊断

目的：探讨下肢动脉瘤的MRI检查方法和表现。方法：8例经手术和病理证实的下肢动脉瘤,7例为假性动脉瘤,1例为真性动脉瘤。全部病例均采用SE序列,常规MRA和动态增强MRA检查。结果：7例假性动脉瘤悬挂于母体血管的一侧,狭颈,犹如藤上的果实,具有特征性表现。囊状真性动脉瘤位于母体血管的一侧,呈宽基底,动态增强与母体血管显影、排空一致,为特征性改变。全部病例SE序列,均显示病变部位、范围和大小。常规MRA和增强MRA可清楚显示动脉瘤和母体血管的空间关系,可作出真性动脉瘤和假性动脉瘤的准确诊断。结论：MRI对下肢动脉瘤的诊断较为满意,基本上可以替代血管造影。     

3D-T0F MRA对颅内动脉瘤GDC治疗随访的预期评估

目的：评价磁共振血管成像(MRA)在随访43例病人的45个颅内动脉瘤GDC栓塞后的价值。材料和方法：以数字减影血管造影(DSA)作为诊断的金标准，回顾研究43例病人的45个颅内动脉瘤(前循环34个，后循环11个)MRA检查。所有的病人在GDC栓塞治疗后9个月之内的同一周行DSA和MRA检查，这期间不作处理。分析弹簧圈内残余血流、载瘤动脉和邻近动脉血流，MRA以最大强度投影(MIP)重建和源图像为基础。结果：所有病例中，MRA能提供良好的信息。对于动脉瘤的分析，MRA的敏感性、特征性、阳性预测价值、阴性预测价值，诊断弹簧圈内残余血流分别为87．5％、100％、100％、97％，诊断瘤颈的残余血流分别为90％、100％、100％、97％。对于动脉通畅性分析，MRA的敏感性和阴性预测价值，载瘤动脉分别是90．5％和100％，邻近动脉分别是85．7％和100％。结论：在随访GDC栓塞的动脉瘤中，MRA可以作为一个筛选手段，提高检查效率，减少病人的随访风险。     

颈位主动脉弓伴动脉瘤的MRI及MRA表现

目的：分析颈位主动脉弓伴动脉瘤的MRI及MRA表现，初步探讨两种方法对其诊断价值。方法：3例颈位主动脉弓伴动脉瘤均作MRI检查，其中1例作时间飞跃法磁共振血管成像（2-dimensional time-of-flightMRA,2DTOFMRA)检查，1例作3DDCEMRA检查，另1例同时作2DTOF MRA及3DDCEMRA检查。结果：MRI与MRA均能明确诊断颈位主动脉弓，对弓上分支血管的显示，MRA优于MRI，3DDCEMRA优于2DTOFMRA，对动脉瘤的显示，MRI与3DDCEMRA优于2DTOFMRA，结论：对于颈位主动脉弓伴动脉瘤的显示，应选用3D DCEMRA及MRI两种检查方法。     

多发性大动脉炎的MRI诊断

目的：探讨多发性大动脉炎的MRI检查方法和诊断价值。方法：41例临床确诊为多发性大动脉炎进行MRI SE序列和MRA检查，其中35例行动态增强MRA。41例中的11例同时行血管造影，26例行彩超检查。结果：41例MRI检查共显示血管狭窄、闭塞145段，动脉瘤9个，与血管造影、彩超对照比较，二会合率均＞90％。结论：MRI SE序列，常规MRA和动态MRA的联合应用，可准确、直观地显示多发性大动脉炎血管受累的性质、范围和程度，基本上可以替代血管造影。     

16层螺旋CT血管造影在颅内动脉瘤中的应用价值

目的探讨16层螺旋CT血管造影(CTA)对颅内动脉瘤的诊断价值。方法28例疑有颅内动脉瘤患者均行16层CTA和DSA检查,对CTA的表现结合DSA和手术结果进行回顾性分析。结果本组28例经CTA共检出动脉瘤27个,其中25个经手术和DSA证实。1例CTA显示动脉瘤2个,DSA只显示1个,另1例CTA显示可疑动脉瘤2个,DSA显示正常。16层CTA诊断颅内动脉瘤的敏感性为89.2%,特异性为100%,准确性为96.4%。结论16层CTA在显示颅内动脉瘤方面可与DSA媲美,有重要临床应用价值。     

MRA与CTA在颅内动脉瘤诊断价值的比较

目的探讨磁共振血管成像（MRA）、X线计算机体层摄影血管成像（CTA）在颅内动脉瘤诊断中的价值。方法以数字血管造影（DSA）检查结果为金标准,回顾性分析47例经DSA诊断为颅内动脉瘤患者的MRA、CTA影像资料,对比两者对颅内动脉瘤的检出率及瘤体大小的差异。结果47例DSA诊断颅内动脉瘤52个;MRA诊断42例共检出46个动脉瘤,阳性率为88．5％（46／52）;CTA诊断44例共检出49个动脉瘤,阳性率为94．2％（49／52）。二者检出率的差异无统计学意义（P=0．49）。MRA显示瘤体直径为5～23mm,平均（9．72土5．68）mm,而CTA显示瘤体直径为3-25mm,平均（9．85土5．81）mm,瘤体直径的差值无统计学意义（P=0．17）。结论MRA与CTA对颅内动脉瘤诊断无明显差别,临床可根据实际条件选择合适的检查方法,从而达到最佳诊断和治疗的目的。     

成人型moya moya病的MR和MRA诊断(附6例分析)

目的：分析成人型moyamoya病的MRI和MRA影像特征。方法：回顾性分析6例经DSA证实的成人moyamoya病的MRI及MRA影像资料，采用GE1.5T超导型MR扫描系统行SE、FSE序旬MRI和三维时间飞跃法MRA。结果：成人型moyamoya病主要表现为多发腔隙性梗塞、脑萎缩，或并发脑实质出血、蛛网膜下腔出血。MRI显示闭塞的颅底大血管流空效应消失，兵脑和基底节区侧支循环流空信号增多，脑实质缺血或出血改变。MRA直接显示狭窄或闭塞的预内动脉（ICA）、大脑中动脉（MCA）、大脑前动脉（ACA）及侧支血管网。与DSA对比，MRA能够准确地显示闭塞或狭窄的大血管和代偿的不成形的弯延扭曲的侧支血管网。结论：MRI和MRA相结合可正确诊断moyamoya病，MRA是一种无创、短时、成功率和准确性高的检查方法，也可用于筛选可疑颅内动脉狭窄或闭塞的患者，避免或减少血管造影的次数。     

Diagnostic accuracy of 3D time-of-flight MR angiography compared with digital subtraction angiography for follow-up of coiled intracranial aneurysms: influence of aneurysm size

BACKGROUND AND PURPOSE: 3D time-of-flight MR angiography (3D TOF MRA) may be used as noninvasive alternative to digital subtraction angiography (DSA) for the follow-up of patients with intracranial aneurysms treated with Guglielmi detachable coils (GDCs). We aimed to determine the influence of aneurysm size and location on diagnostic accuracy of 3D TOF MRA for follow-up of intracranial aneurysms treated with GDCs. MATERIALS AND METHODS: Two hundred and one 3D TOF MRAs in 127 consecutive patients with 136 aneurysms were compared with DSA as standard of reference. Sensitivity and specificity of 3D TOF MRA for detection of residual or reperfusion of the aneurysms was calculated with regard to aneurysm size and location. RESULTS: Overall sensitivity and specificity of MRA was 88.5% and 92.9%, respectively. Sensitivity was lower for aneurysms 相似文献   

Three-dimensional time-of-flight (3D TOF) magnetic resonance angiography (MRA) and contrast-enhanced MRA of intracranial aneurysms treated with platinum coils

Background: Contrast-enhanced magnetic resonance angiography (CE-MRA) is less prone to flow-related signal intensity loss than three-dimensional time-of-flight (3D TOF) MRA and may therefore be more sensitive for detection of residual patency in platinum coil-treated intracranial aneurysms.

Purpose: To compare MRA and CE-MRA in the follow-up of intracranial aneurysms treated with platinum coils.

Material and Methods: CE-MRA and 3D TOF MRA (pre- and postcontrast injection) of the intracranial vasculature was performed at 1.5T in 38 patients (47 aneurysms) referred for DSA in the follow-up of coiled intracranial aneurysms.

Results: DSA showed aneurysm patency in 22/47 investigations. Patent aneurysm components were observed with CE-MRA in 18/22 cases, and with 3D TOF MRA in 21/22 cases. There was no significant difference in patent aneurysm component size between CE-MRA and 3D TOF MRA. In addition, CE-MRA showed six, 3D TOF MRA before contrast injection showed seven, and 3D TOF MRA after contrast injection showed eight cases with patent aneurysm components not observed on DSA.

Conclusion: 3D TOF MRA was highly sensitive for detection of patent aneurysm components, and at least as sensitive as CE-MRA. Residual aneurysm patency seems to be better visualized with MRA than with DSA in some cases.     

MR angiography at 3T versus digital subtraction angiography in the follow-up of intracranial aneurysms treated with detachable coils

BACKGROUND AND PURPOSE: Digital subtraction angiography (DSA) is used to follow-up intracranial aneurysms treated with detachable coils to identify recurrence and determine need for additional treatment. However, DSA is invasive and involves a small risk of neurologic complications. We assessed the feasibility and usefulness of 3D time-of-flight (TOF) MR angiography (MRA) performed at 3T compared with DSA for the follow-up of coil-treated intracranial aneurysms. METHODS: In a prospective study, 20 consecutive patients with 21 intracranial aneurysms treated with coils underwent DSA and nonenhanced and enhanced multiple overlapping thin-slab acquisition 3D TOF MRA at 3T on the same day at a mean follow-up of 6 months (range, 4-14 months) after coil placement. MRA images were evaluated for presence of artifacts, presence and size of aneurysm remnants and recurrences, patency of parent and branch vessels, and added value of contrast material enhancement. MRA and DSA findings were compared. RESULTS: Interobserver agreement of MRA was good, as was agreement between MRA and DSA. All three recurrences that needed additional treatment were detected with MRA. Minor disagreement occurred in four cases: three coil-treated aneurysms were scored on MRA images as having a small remnant, whereas on DSA images these aneurysms were occluded; the other aneurysm was scored on MRA images as having a small remnant, whereas on DSA images this was a small recurrence. Use of contrast material had no additional value. Coil-related MR imaging artifacts were minimal and did not interfere with evaluation of the occlusion status of the aneurysm. CONCLUSION: High-spatial-resolution 3D TOF MRA at 3T is feasible and useful in the follow-up of patients with intracranial aneurysms treated with coil placement.     

CTA与MRA诊断动脉瘤及评估动脉瘤破裂风险的比较

 目的 比较CT血管造影术(CT angiography,CTA)与磁共振血管造影(magnetic resonance angiography,MRA)诊断动脉瘤与动脉瘤破裂的风险评估价值。方法 48例高度怀疑为颅内动脉瘤患者随机分为两组,每组24例,记为Ⅰ组和Ⅱ组,其中Ⅰ组行CTA+DSA检查,Ⅱ组行MRA+DSA检查。比较CTA及MRA对颅内动脉瘤的诊断灵敏度、诊断特异性、阳性预测值、阴性预测值及准确率。比较CTA及MRA对5 mm以上动脉瘤的诊断价值。结果 MRA诊断颅内动脉瘤的诊断灵敏度、诊断特异性、阳性预测值、阴性预测值、准确率较CTA稍低,但二者差异无统计学意义。CTA与三维增强MR血管成像(3D CE-MRA)对5 mm以上动脉瘤的诊断能力相当,但与三维时间飞跃法MR血管成像(3D TOF MRA)相比,CTA与CE-MRA的诊断灵敏度、诊断特异性、阳性预测值、阴性预测值、准确率明显较高,差异有统计学意义(P<0.05);CTA能更清楚地显示瘤颈。结论 CTA和MRA可作为诊断动脉瘤与动脉瘤破裂的风险评估的首要手段,CTA诊断的准确率及三维形态高于MRA。     

脑动脉瘤的MR血管造影与IA—DSA的对照研究

对经手术证实的２０例脑动脉瘤的ＭＲＡ和ＩＡ－ＤＳＡ的影像进行了对照分析研究，经ＭＲＡ检出１９例（９５％）动脉瘤，１０ｍｍ以下的动脉瘤９例，最小的为４ｍｍ，与ＤＳＡ检出率（１９／２０）相仿。ＭＲＡ的定位符合率为８４％，低于ＤＳＡ（９５％）。１３／１９例（６８％）在ＭＲＡ图象上能显示动脉瘤的瘤颈。作者认为ＭＲＡ是一种新的非侵入性的血管影像方法，可作为脑动脉瘤高危病例的筛选检查，随着ＭＲＡ技术的进一步完善，ＭＲＡ有望在神经外科领域替代部分侵入性血管造影检查。     

颅内动脉瘤 3D DCE-MRA与DSA对照研究

目的 探讨三维动态增强MR血管造影(3D DCE-MRA)在颅内动脉瘤诊断中的价值. 资料与方法 对39例临床拟诊动脉瘤和常规MRA可疑动脉瘤的患者行3D DCE-MRA,随后行DSA,比较两种方法 对颅内动脉瘤的显示情况. 结果 34例动脉瘤患者中共有动脉瘤41个,3D DCE-MRA对动脉瘤诊断的敏感性为95%,特异性为80%,准确性为85%,3D DCE-MRA与DSA比较,差异无统计学意义(P>0.05). 结论 3D DCE-MRA是一项无创、安全、简便和可靠的诊断颅内动脉瘤的方法,对于颅内较大血管的动脉瘤的显示,可以取代DSA.     

Three-dimensional time-of-flight MR angiography for evaluation of intracranial aneurysms after endosaccular packing with Guglielmi detachable coils: comparison with 3D digital subtraction angiography

The sensitivities and specificities of three-dimensional time-of-flight MR angiography (3D-TOF MRA) and 3D digital subtraction angiography (3D-DSA) were compared for evaluation of cerebral aneurysms after endosaccular packing with Guglielmi detachable coils (GDCs). Thirty-three patients with 33 aneurysms were included in this prospective study. 3D-TOF MRA and 3D-DSA were performed in the same week on all patients. Maximal intensity projection (MIP) and 3D reconstructed MRA images were compared with 3D-DSA images. The diameters of residual/recurrent aneurysms detected on 3D-DSA were calculated on a workstation. In 3 (9%) of 33 aneurysms, 3D-TOF MRA did not provide reliable information due to significant susceptibility artifacts on MRA. The sensitivity and specificity rates of MRA were 72.7 and 90.9%, respectively, for the diagnosis of residual/recurrent aneurysm. The diameters of residual/recurrent aneurysms that could not be detected by MRA were significantly smaller than those of detected aneurysms (mean 1.1 vs mean 2.3 mm). In one aneurysm of the anterior communicating artery (ACoA), the relationship between the residual aneurysm and the ACoA was more evident on MRA than DSA images. MRA can detect the recurrent/residual lumen of aneurysms treated with GDCs of up to at least 1.8 mm in diameter. 3D-TOF MRA is useful for follow-up of intracranial aneurysms treated with GDCs, and could partly replace DSA.     

3D-SPACE序列结合3D-TOF MR血管成像在颅内动脉瘤支架辅助弹簧圈栓塞术后随访中的应用

目的探讨三维T1加权序列可变反转角度快速自旋回波序列(3D T1-SPACE)结合三维时间飞跃法MR血管成像(3D-TOF MRA)在颅内动脉瘤支架辅助弹簧圈栓塞术后患者随访中的应用价值。方法前瞻性收集2017年12月至2018年10月河南省人民医院收治的25例因颅内动脉瘤接受支架辅助弹簧圈栓塞术的患者,均为宽颈动脉瘤。术后6~10个月所有患者均行3D-TOF MRA、3D T1-SPACE序列MR扫描和DSA检查。分别使用3D-TOF MRA和DSA以Raymond分级法评价瘤腔栓塞情况,使用3D-TOF MRA和3D T1-SPACE序列以4分法评价载瘤动脉支架内管腔显示情况。采用配对设计的Wilcoxon秩和检验比较动脉瘤栓塞程度分级和支架内管腔显示情况。以DSA为金标准,计算3D-TOF MRA评估动脉瘤残留的特异度及准确率。结果术后6~10个月随访,对于动脉瘤闭塞情况,DSA造影显示Raymond 1级23例,2级1例,3级1例;3D-TOF MRA 1级21例,2级3例,3级1例;差异无统计学意义(Z=-0.557,P=0.577),其中有4例患者两种评估方法结果不一致。对于载瘤动脉支架内管腔情况的显示,3D-TOF MRA评分3分14例,2分8例,1分3例;3D T1-SPACE序列25例均为4分,3D T1-SPACE优于3D-TOF MRA(Z=-4.484,P<0.001)。以DSA为金标准,3D-TOF MRA结合原图像评估动脉瘤栓塞情况的特异度为86.9%(20/23),准确率为84.0%(21/25)。结论3.0 T MR 3D T1-SPACE序列可清晰显示支架内管腔,能准确判断支架内血管的通畅情况,3D-TOF MRA可充分评估动脉瘤瘤腔有无残留。将上述两种MRI血管成像技术相结合,可用于动脉瘤支架辅助栓塞术后的随访。     

Time-of-flight MR angiography targeted to coiled intracranial aneurysms is more sensitive to residual flow than is digital subtraction angiography

BACKGROUND AND PURPOSE: For intracranial aneurysms treated with Guglielmi detachable coils, long-term follow-up is mandatory because coil compaction may occur and aneurysms may recur. The purpose of this study was to establish a noninvasive technique to visualize residual flow in coiled aneurysms. METHODS: We designed a 3D time-of-flight (3D-TOF) MR angiography (MRA) technique targeted to depict coiled aneurysms that employed a very short TE (1.54-1.60 ms) and a high spatial resolution (0.3 x 0.3 x 0.3 mm3 with zero-filling) to diminish spin dephasing. To diminish spin saturation, image volume was carefully positioned so that the neck of the targeted aneurysm was within 2 cm of the inflow portion along the stream of blood. Fifty-one MRA images of 39 coiled aneurysms in 39 patients were compared with digital subtraction angiography (DSA) images. DSA and MRA findings were interpolated retrospectively for parent and branch arteries' patency, as well as residual flow in aneurysms. In the latest 11 MR studies, a dark-blood 3D turbo spin-echo sequence was added to MRA to negate the effect high-signal-intensity thrombus. RESULTS: MRA visualized all parent and branch arteries with DSA confirmation. MRA visualized residual flow more frequently (38 studies) than did DSA (25 studies). Residual flow space visualized with MRA was always similar to or larger than that with DSA. The dark-blood sequence completely suppressed intraluminal high signal intensity on MRA images and confirmed that the high signal intensity was not due to thrombus. CONCLUSION: TOF MRA targeted to depict coiled intracranial aneurysms is noninvasive and superior to DSA in visualization of residual flow and, hence, useful for follow-up of coiled aneurysms.