三维增强MRA在外伤性下肢血管损伤的应用价值

目的:评价三维增强磁共振血管造影(3D CE_M RA)及其后处理三维重建技术在外伤性下肢血管损伤的应用价值。方法:12例临床初诊为外伤性下肢血管损伤患者行3D CE_M RA及常规M R I检查,3D CE_M RA使用高分辨率三维快速小角度激发(3D flash)梯度回波序列,1次采集时间约18 s~20 s,应用二段移床技术,一次检查完成下肢血管成像;工作站三维重建,观察下肢血管损伤、动脉与静脉血栓形成等情况。常规行平扫及增强扫描,采用真正快速稳态进动梯度回波(true_fisp)序列、半傅立叶采集单次激发快速自旋回波(H aste_T2W I)序列,与2D flash_T1W I序列,了解患肢肌肉血供与肌肉坏死情况,为临床选择术式提供依据。结果:12例下肢血管损伤3D CE_M RA检查中,3例为动脉破裂伴假性动脉瘤形成,5例为动脉完全中断分离,2例为动静脉同时中断,1例为动静脉瘘,1例为动脉主干受压狭窄,其中损伤动脉远端血栓形成1例,静脉血栓形成1例。根据M RA检查结果,11例患者选择手术修补或血管重建,1例行截肢手术,手术结果与M RA所见血管损伤一致,只是静脉血栓术中未发现,符合率为92.8%。结论:3D CE_M RA三维血管成像能清晰、直观再显下肢血管,诊断准确率高,且有无创伤、无辐射及无肾毒性造影剂等优势,可作为外伤性下肢血管损伤的术前常规检查,具有极高的临床应用价值。

The Value of the Application of Three-Dimension MRA in Traumatic Injury of Vessel of Low Extremity

Objective To evaluate the application of three-dimension MRA(3D CE_MRA) and postproccessing three dimension reconstruction in traumatic injuries of vessel of low extremity.Methods Total 12 cases,which were suspected of traumatic injury of vessel have normal and 3D CE_MRA scans.The scan method was:three dimension fast low angle shot gradient echo sequences(3D-flash),18 seconds～20 seconds of each acquisition time,two section of bed moving,complete data acquisition of whole span of vessel of low extremity at one time;reconstructing the vessel in workstation immediately after scan and the image was observed to judge the injury of vessel、formation of thrombosis in artery or vein and so on.To get the information of blood supply and necrosis of muscle for clinical selection of surgical pattern,the normal and enhanced scan was performed with true fast steady precession gradient echo(true_fisp)、half-fourier single turbo spin echo(Haste)T_2WI and two-dimension fast low angle shot gradient echo sequences.Results Total 12 patients were scanned,Arterial rupture companied with false aneurysm were 3,1 A-V fistula,5 complete interruption of artery,2 interruption of both artery and vein,1 stenosis of trunk of artery,thrombosis was found in distal end of artery 1 case and in vein 1 case each.Based on the MRA image,11 patients were undergone neoplasty or reconstruction, the left one was applied with amputation.all operative result was coincident with findings of MRA,only one thrombosis in vein was not found,coincidence rate was 92.8%.Conclusions 3D CE_MRA can distinctively and direct reappear the low extremity artery and have high accuracy and,with other advantage like no invasive,no radiation and no renal toxicity,can be used as routine examination before the surgery of traumatic injury of vessel which also have extreme high clinical value.