三维增强MR血管成像在周围型动脉闭塞症分级中的应用价值

目的探讨三维增强MR血管成像（3DCE-MRA）在周围型动脉闭塞症（PAOD）分级中的应用价值。方法选择25例临床诊断为PAOD的患者进行3D CE-MRA扫描，采用连续动床三段采集法，高压注射36ml钆喷替酸葡甲胺（GD-DTPA），将采集到的图像进行最大信号投影（MIP）、多平面重组（MPR）或者容积重组（VRT）。结果25例患者成功行3DCE-MRA检查，腹主动脉下段至小腿动脉显示对比度均可达到诊断要求，与DSA和（或）手术结果相比较，3DCE-MRA诊断PAOD总符合率达96．95％（509／525），诊断轻度狭窄、中度狭窄、重度狭窄和闭塞的符合率分别为84．62％（44／52）、84．85％（28／33）、95．45％（21／22）、98．67％（74／75），对轻度、中度、重度狭窄的高估率分别为11．54％（6／52）、12．12％（4／33）、4．55％（1／22），对轻度、中度、重度狭窄和闭塞的低估率分别为3．85％（2／52）、3．03％（1／33）、0（0／22）、1．33％（1／75）。结论3DCE-MRA可以对下肢动脉的狭窄和闭塞进行准确定位和分级，在临床应用中具有重要价值。     

下肢动脉慢性闭塞症的MRA诊断

目的：对ＭＲＡ在下肢动脉慢性闭塞症中的诊断价值作一初步评估。材料与方法：５４例下肢动脉慢性闭塞症患者，行二维时间飞跃法ＭＲＡ检查，范围包括主动脉下段、髂动脉、股动脉、动脉及其三分支。其中２１例同时行动脉造影，１８例手术探查。结果：２１例ＭＲＡ与动脉造影对照，可比动脉节段１６８个，其中正常或轻度狭窄４６个节段，中度狭窄２７段，重度狭窄４６段，闭塞４９段，两者符合率为９２．２６％（１５５／１６８）。１８例与手术对照，可比动脉节段８２个，符合率为９２．６８％（７６／８２）。同时进行的２３例双功能多普勒超声测定踝／肱指数显示，踝／肱指数＜０．５，ＭＲＡ显示血管为重度狭窄或闭塞。结论：下肢动脉ＭＲＡ与手术、动脉造影、踝／肱指数比较，具有很好的一致性，能比较准确地评价下肢动脉慢性闭塞性病变，尤其对重度狭窄和闭塞准确性较高。     

下肢动脉闭塞性疾病64层CT血管成像中腘动脉小剂量对比剂试验的意义

目的 探讨下肢动脉闭塞性疾病采用64层CT血管成像时,在腘动脉行小剂量对比剂试验的意义.方法 连续选取28例临床怀疑下肢动脉闭塞性疾病患者,应用64层CT在两侧腘动脉(膝关节层面)各设置一ROI进行小剂量对比剂试验,明确显示峰值及达峰时间者认为曲线获取成功.分析两侧腘动脉峰值、达峰时间、左右两侧的差异,及其对下肢动脉CTA的影响,并采用Pearson相关法分析达峰时间与峰值的相关性.根据达峰时间采用快速模式启动扫描,并将图像质量分为优、良、差3个级别按节段进行评价,计算优和良的动脉节段数占总节段数的百分比即优良率.结果 28例患者中获取腘动脉小剂量对比剂曲线的成功率为96%(54/56).26例获得双侧小剂量对比剂曲线的患者中,腘动脉峰值及达峰时间差异较大,分别为60～178(135±28)HU,21～46(31±6)s.左右腘动脉峰值及达峰时间差异亦较大,19例左右峰值不一致,差值10～80 HU,平均(32±18)HU;21例左右达峰时间不一致,差值1～12 s,平均(5±3)s.达峰时间与峰值呈负相关(r= -0.526,P<0.01).下肢CTA 616个动脉节段中,成像质量优598个,良12个,优良率为99%(610/616).结论 下肢动脉闭塞性疾病采用64层CT血管成像时,应用腘动脉小剂量对比剂试验可以准确把握扫描时机,从而获得良好的血管成像质量.

Abstract：

Objective To investigate the clinical value of the test injection at popliteal arteries on 64-slice CTA in lower extremity peripheral arterial occlusive disease (PAOD). Methods Twenty-eight patients with PAOD referred for 64-slice CTA were enrolled consecutively in the study. Test injection was performed at bilateral popliteal arteries (the level of knee joints) and the clinic value of the peak value and the time to peak was analyzed. The relationship between the time to peak and the peak value was evaluated with Pearson test. The time to peak was used for programming of the CT angiographic acquisitions with fast scanning mode. The quality of visualization of each arterial segment was determined independently by two radiologists. Results Fifty-four (96%, 54/56) time-attenuation curves were obtained in 28 patients. The wide interindividual variation in the peak value and the time to peak was observed in 52 curves of 26 patients with range of 60-178 HU,21-46 s and an average of (135±28) HU,(31±6) s, respectively. The difference in the peak value and the time to peak between bilateral popliteal arteries was also observed with range of 10-80 HU and an average of (32±18) HU in 19 patients,with range of 1-12 s and an average of (5±3) s in 21 patients. There was negative relationship between the peak value and the time to peak (r=-0.526, P<0.01). The CTA images were of good (598 segments) or medium quality (12 segments) in 99% segments (610/616). Conclusions The test injection at popliteal arteries was useful for 64-slice CTA in the patients with PAOD, as it could accurately specify the delay time of CT angiographic acquisitions.     

CE-MRA在外周血管闭塞性疾病诊断中的应用

目的:介绍对比增强磁共振血管成像(CE-MRA)在外周血管闭塞性疾病诊断中的方法及应用体会。方法:2005年2~7月间36例临床怀疑下肢动脉闭塞症患者行自动移床三维增强磁共振血管成像(3D CE-MRA)检查,范围包括主动脉、髂动脉、股动脉、腘动脉及其三个分支。结果:36例中32例下肢动脉可见不同部位、不同程度的狭窄及闭塞。阳性诊断率89%。与数字减影血管造影(DSA)检查结果符合率94%。结论:正确掌握检查方法,可以获得良好的图像质量。自动移床3D CE-MRA是一种无创的、简便而有效的下肢血管性病变的检查方法。     

影像学血管成像在下肢血管闭塞性疾病中的应用进展

下肢血管闭塞性病变严重的威胁了老年人口生命健康,是导致其生活质量下降的主要原因之一,医学影像学血管成像技术在下肢血管闭塞性病变的诊断与随访中具有重要作用,本文综述了下肢血管成像的各种影像学方法,比较了各种成像方法的优缺点,并对新近研究的医学影像学下肢血管成像技术作了介绍及展望。     

慢性大脑中动脉狭窄与闭塞的MR灌注成像研究

目的:探讨单侧大脑中动脉(MCA)慢性重度狭窄、闭塞患者的MR脑灌注成像表现及其应用价值.方法:28例单侧MCA慢性重度狭窄或闭塞患者行MR脑灌注成像检查,得出有关脑灌注参数图,包括相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)和达峰时间(TTP)图,对灌注成像表现进行定性和定量分析.结果:28例MCA慢性重度狭窄或闭塞患者,磁共振灌注加权成像(PWI)均发现病变侧灌注异常,病变侧rCBV、rMTT和TTP与对侧比较差异有显著性意义(P＜0.01),rCBF差异无显著性意义(P＞0.05).rMTT和TTP图显示病变侧较对侧明显延迟,24例仅累及MCA供血区,4例同时累及MCA和分水岭区.结论:PWI检查能够显示单侧MCA慢性重度狭窄或闭塞患者脑血流动力学受损情况,对临床诊断和治疗具有重要价值.     

双源64排螺旋CT血管成像对下肢动脉狭窄及闭塞性病变的诊断价值

目的：通过双源64排螺旋CT血管成像（CTA）与数字减影血管造影（DSA）进行比较,探讨双源64排螺旋CTA对下肢动脉狭窄及闭塞性病变的诊断价值。方法采用德国西门子公司生产的双源64排螺旋CT对30例临床怀疑下肢动脉狭窄及闭塞性病变的患者进行双下肢动脉血管成像检查,扫描范围自腹主动脉下段至足底,扫描层厚0．75 mm,管电压120 kV,管电流250 mAs,将原始图像送入工作站进行图像后处理,主要包括容积再现（VR）、最大密度摄影（MIP）、多平面重建（MPR）、曲面重建（CPR）,并结合原始图像进行分析,所有患者1周后行DSA检查,以DSA作为参考标准,对诊断一致性、敏感性、特异性和狭窄部位的检出准确率进行计算。结果在720个动脉节段中,700个节段在CTA和DSA均可以显示,以DSA作为诊断标准,双源64排螺旋CTA诊断下肢动脉闭塞的敏感性、特异性、准确性分别为99.3％、97．8％、97．8％;对于显示中度以上的狭窄,双源64排螺旋CTA的敏感性、特异性、准确性分别为99．7％、97．6％、95．6％;双源64排螺旋CTA在诊断下肢动脉狭窄及闭塞性病变与DSA结果一致性好（kappa值＝0．937）。结论双源64排螺旋CTA可以作为下肢动脉狭窄及闭塞性病变的首选检查手段,对临床具有重要的指导价值。     

基于杂合动脉自旋标记改进型静音MR血管成像对颅内动脉狭窄闭塞性疾病的成像价值

目的:探讨基于杂合动脉自旋标记（ASL）改进型静音MRA技术在颅内动脉狭窄性疾病成像中的稳定性以及可行性。方法:收集2019年9月至2020年5月经苏北人民医院神经内科临床怀疑的颅内血管狭窄及闭塞患者35例,分别进行静音MRA以及基于杂合ASL技术改进型静音MRA,评估2种MRA检查的采集噪声（噪声测量、主观评分）。2...     

高分辨对比增强三维MR血管成像对显示肝动脉的价值

目的与DSA对照，评估高分辨对比增强三维MR血管成像（high-resolution 3D MRA）显示肝动脉解剖的价值。方法回顾性分析26例肝肿瘤（24例为原发性肝癌，2例为转移性肝癌）患者腹部高分辨对比增强3D MRA和DSA检查的资料。对高分辨对比增强3D MRA和DSA的各段肝动脉显影质量行4级评分（1级记为1分，2级为2分，3级为3分，4级为4分），并对两者显影质量行weighted Kappa分析；分析评估肝动脉解剖或变异，以及病理情况，与DSA进行比较。结果26例患者高分辨对比增强3D MRA和DSA对肝总动脉（显影评分平均为3．96、3．96）、胃十二指肠动脉（评分为3．85、3．88）的显示有很好的一致性（Kappa值分别为0．99、0．85），对肝右动脉（评分为3．92、3．96）、肝左动脉（评分为3．77、3．92）、胃左动脉（评分为3．73、3．85）、肝右前（评分为3．35、3．70）和右后动脉（评分为3．31、3．73）及第Ⅳ段动脉（评分为2．92、3．46）有较好的一致性（Kappa值分别为0．65、0．43、0．43、0．53、0．46、0．51），而对肝第Ⅱ（评分为2．15、3．35）、Ⅲ段动脉（评分为2．19、3．35）一致性差（Kappa值分别为0．18、0．21）。以DSA为标准，高分辨对比增强3D MRA准确显示18例正常解剖和7例变异[显示的准确度为96．1％（25／26）]，1例胃十二指肠动脉闭塞。结论高分辨对比增强3D MRA是一项能准确评估肝动脉的检查技术，可以达到肝段动脉的显示水平。     

CT angiography of peripheral arterial occlusive disease

Lower extremity computed tomography angiography (CTA) is an effective, noninvasive, and robust imaging modality that is being used increasingly to evaluate patients with peripheral arterial occlusive disease (PAOD). It is important for vascular and interventional radiologists, and vascular surgeons to be familiar with the strengths and limitations, diagnostic accuracy, and practical application of lower extremity CTA. In this article, we review the technical principles of image acquisition, visualization techniques to effectively interpret the large volumetric datasets generated, and the current practical application of lower extremity CTA with respect to PAOD.     

Standard-protocol moving-table magnetic resonance angiography for planning of interventional procedures in patients with peripheral vascular occlusive disease

PURPOSE: This study aimed to evaluate the usefulness of magnetic resonance angiography (MRA) for the planning of interventional procedures in the lower extremity vascular territory. MATERIALS AND METHODS: Patients with peripheral vascular occlusive disease (PVOD) underwent MRA for planning of percutaneous interventional treatment. Digital subtraction angiography was performed in patients scheduled for interventional treatment and served as the standard of reference. RESULTS: In 148 out of 150 cases (98.7%), the necessity for an intervention was recognized correctly; 137 out of 150 interventions (91.3%) were correctly planned based on MRA results. CONCLUSION: Contrast-enhanced MRA of the lower extremities is a safe, noninvasive tool for preinterventional assessment of patients with PVOD. It allows exact planning of endovascular interventions.     

Comparison of contrast‐enhanced MR angiography to intraarterial digital subtraction angiography for evaluation of peripheral arterial occlusive disease: Results of a phase III multicenter trial

Purpose

To evaluate the efficacy and safety of 0.1 mmol/kg gadodiamide administration for contrast‐enhanced magnetic resonance angiography (CE‐MRA) in detecting hemodynamically relevant main stenosis (ie, ≥50% or occlusion) of aortoiliac arteries.

Materials and Methods

In a multicenter, phase 3, controlled study, patients with suspected or proven peripheral arterial occlusive disease (PAOD) underwent CE‐MRA with administration of gadodiamide. Intraarterial digital subtraction angiography (IA‐DSA) was used as the reference. The study was approved by all Institutional Review Boards or Institutional Ethic Committees prior to commencement of patient recruitment and written informed consent was obtained from all patients.

Results

Independent readers rated 25%–45% of CE‐MRA images as excellent compared with 0.3%–6% of noncontrast MRA images. Mean imaging acquisition time for CE‐MRA was <1 minute (0.7 ± 1.9 minutes) versus 10 minutes (10.8 ± 3.0) for noncontrast MRA. Sensitivity, specificity, and accuracy of CE‐MRA were superior compared with those of noncontrast MRA in detecting significant arterial stenoses. Compared with IA‐DSA, the sensitivity of CE‐MRA ranged from 80%–88% and the specificity from 73% to 92% for the three blinded readers, at the patient level.

Conclusion

Diagnostic results with CE‐MRA were superior and more consistent compared with noncontrast MRA for detecting hemodynamically relevant main stenoses in patients with suspected or proven PAOD and compared favorably with IA‐DSA as a reference standard. J. Magn. Reson. Imaging 2010;31:1402–1410. © 2010 Wiley‐Liss, Inc.     

非增强MRA诊断下肢动脉病变的应用研究

目的：探讨QISS非增强MRA技术诊断下肢动脉闭塞性病变的临床应用价值。方法：51例下肢动脉病变患者行双下肢QISS-MRA和CE-MRA扫描,评价两种检查方法的图像质量,并以CE—MRA为参照标准,计算QISSMRA诊断下肢动脉显著性狭窄（≥50％）的敏感度、特异度、阳性预测值、阴性预测值和诊断准确性,并以配对χ2检验分析两种检查方法对诊断下肢动脉显著性狭窄（≥50％）的差异有无统计学意义,两种检查方法的相关性采用kappa检验。结果：51例中48例成功行QISS-MRA检查,其中图像质量优、良、差者分别为40（78．43％）、8（15．69％）和3例（5．88％）。按血管节段计算,QISS-MRA诊断下肢动脉显著性狭窄的敏感度和特异度分别为90．15％和98．87％,阳性预测值和阴性预测值分别为96．75％和96．42％,总体符合率为95．91％。对于下肢动脉显著性狭窄的诊断,QISS-MRA与CE-MRA的差异无统计学意义（χ2=3．76,P〉0．05）,且两种检查方法具有极好的相关性（r值为0．950,P〈0．001）。结论：QISS-MRA检查成功率较高、图像质量良好并且诊断效果接近CE—MRA,对诊断下肢动脉闭塞性病变有一定的临床应用潜力。     

Total-body 3D magnetic resonance angiography influences the management of patients with peripheral arterial occlusive disease

High-resolution total-body 3D MR angiography (MRA) has recently become available, revealing additional clinically relevant disease in patients with peripheral arterial occlusive disease (PAOD). However, the actual impact of total-body MRA on patient management in patients with PAOD has not been investigated so far. Two hundred forty-nine consecutive patients with angiographically proven PAOD were prospectively examined by means of contrast-enhanced total-body 3D MRA on a 1.5-T MR scanner. All correlative imaging studies performed within 60 days of total-body MRA were included in the efficacy analysis. Additional clinically relevant disease (luminal narrowing >50%, aneurysmal changes or dissections) was found in 73 segments (52 patients), including the renal arteries (36 segments), carotid arteries (28 segments), subclavian arteries (four segments) and abdominal aortic aneurysms (AAA) (five segments). Of the 73 segments, 36 were deemed necessary for further investigation by means of focused MRA examinations; the diagnosis was confirmed in all cases. Within the 60-day follow-up period, interventional or surgical therapy outside the peripheral arterial tree was performed in nine patients (11 segments), including carotid endatherectomy and renal artery angioplasty. The outlined total-body 3D MRA approach permits a comprehensive evaluation of the arterial system in patients with atherosclerosis and does indeed have an impact on patient management in patients with PAOD.     

16层螺旋CT血管造影对下肢动脉闭塞性疾病的诊断及其临床价值简

目的：探讨16层螺旋CT血管造影对下肢动脉狭窄及闭塞性病变的临床应用价值。方法对20例下肢动脉闭塞性疾病患者行16层螺旋CT血管造影（CTA）,CTA重建采用最大密度投影（MIP）、容积再现技术（VR）、多平面重组（MPR）及曲面重建（CPR）。将下肢血管分成8段,每段血管的狭窄程度分为：正常、轻度狭窄、中度狭窄、重度狭窄、闭塞5个级别。结果20例患者共显示狭窄段72个,其中髂总动脉狭窄5段,髂外动脉狭窄8段,股动脉狭窄10段,动脉狭窄22段,胫前动脉狭窄11段,胫后动脉狭窄12段,腓动脉狭窄4段。结论16层螺旋CT是下肢动脉狭窄及闭塞性病变的可靠评估方法。     

小腿加压3.0T MRA评估糖尿病下肢血管病变的价值探讨

目的 以DSA为金标准评价小腿加压法3.0 T 增强磁共振血管成像(CE-MRA)在糖尿病下肢血管病变的应用价值.方法 对61例2型糖尿病合并下肢血管病变患者进行双下肢MRA检查,患者平均病程(11.6±6.0)年.使用3.0 T CE-MRA,其中小腿袖带加压后成像者(即加压组)31例,常规成像者30例(即常规组),...