磁共振脑静脉系血管成像技术及其临床应用

目的探讨磁共振脑静脉系血管成像的技术方法和最佳扫描方案，评价磁共振静脉系血管成像技术(MR venography，MRV)对静脉系疾病的诊断价值及临床意义。方法采用二维时间飞跃法MR血管造影(2D-TOF-MRA)、二维相位对比血管造影(2D-PCA)和三维对比增强MR血管造影(3D-CE-MRA)3种血管成像技术分别对20例健康志愿者和20例临床或MRI疑有静脉系疾病的患者行MRV成像，并采用最大强度投影(MIP)、多平面或曲面重建(MPR)及数字减影MRA(DSMRA)技术对图像进行后处理，观察脑静脉系在MRV中的显示情况及脑静脉系疾病在MRV中表现形式，制定脑静脉系成像的最佳方案。结果本组经3D-CE-MRA静脉系成像诊断为13例颅内静脉窦血栓形成(CVST)及7例颅内肿瘤累及静脉系的阳性显示率为100％，均经临床治疗复诊及手术证实。2D-PCA及2D-TOF-MRA对细小引流静脉显示欠佳，且2D-TOF-MRA对复杂区域内静脉血管亦显示欠佳。结论3D-CE-MRA结合2D-PCA及2D-TOF-MRA静脉成像技术形成全脑静脉系成像，为脑静脉系的最佳成像方案，对临床术前评估和指导治疗有极其重要的意义。

Clinical application of MR angiography in the intracranial venous system

Objective To investigate the technique methods and optimal sequences of intracranial MR venography (MRV), and to assess the diagnostic value of MRV and its clinical application in the disorders of intracranial venous system. Methods MRV was conducted by using 2D TOF MRA, 2D PCA, and 3D CE MRA combined with maximum intensity projection (MIP), multi planar reconstruction (MPR), and digital subtraction MRA (DSMRA). MRV imaging was performed in 20 healthy subjects and 20 patients with suspected cranial venous sinus thrombosis (CVST) or intracranial tumor related to venous sinus. MRV imaging results were observed, and the optimal sequences of intracranial venous system in MRV were formulated.Results Of the 20 patients, 13 cases with CVST and 7 cases with intracranial tumor related to venous sinus were demonstrated by 3D CE MRA, and all the lesions were confirmed operatively and pathologically. The positive showing rate was 100% for 3D CE MRA. Visualization of the complicated region and minor venous vessels was better with 3D CE MRA than with 2D PCA and 2D TOF MRA.Conclusion MRV with 3D CE MRA combined with 2D PCA and 2D TOF MRA are the optimal sequences in the demonstration of intracranial venous system. MRV plays an important role in making preoperative evaluation and in guiding clinical management.