3.0T三维时间飞越法MRA对颅内动脉瘤的诊断价值(1)
【摘要】目的：评价3.0T三维时间飞越法磁共振血管摄影术(MRA，3D-TOF MRA)对颅内动脉瘤的诊断价值。方法：对27例高度怀疑有颅内动脉瘤的病人行3D-TOF MRA检查，随后行数控减影血管造影术(DSA)造影及可行的血管内栓塞治疗，工作站上三维重建，比较3D-TOF MRA及常规DSA在显示动脉瘤、瘤颈及与载瘤动脉关系上的优劣，及对血管内栓塞治疗的价值。结果：27例脑动脉瘤患者共20个动脉瘤，3D-TOF MRA对动脉瘤的敏感度为95%，特异度80%，准确度90%。3D-TOF MRA对动脉瘤细节及瘤颈的显示明显优于常规DSA，尤其是颈内动脉海绵窦部及椎动脉近小脑后下动脉的动脉瘤，可指导DSA显示动脉瘤方向及预先制定治疗方案。但对周边部及动脉分叉处小动脉瘤的诊断应谨慎。结论：3D-TOF MRA能无创有效地诊断颅内动脉瘤，所提供的三维信息对治疗方案的制定具有极大帮助。当诊断有怀疑时，应结合DSA检查。
【关键词】脑动脉瘤；磁共振血管造影术；图像处理
, http://www.100md.com 文章编号：1009-5519(2007)23-3480-03 中图分类号：R445 文献标识码：A
The diagnostic value of3.0T three-dimensional time of flight magnetic resonance angiography in intracranial aneurysms
XU Yun-fei,WEI Chuan-she，WANG Zheng-chao,et al.
(Department of Radiology,The Affliated Hospital of Jiangsu University，Zhenjiang 212001，China)
【Abstract】Objective：To evaluate the diagnostic value of 3.0T three-dimensional time of flight magnetic resonance angiography(3D-TOF MRA) in intracranial aneurysms.Methods:3D-TOF MRA was performed in 27 patients highly suspected with intracranial aneurysms.Then conventionl digital subtraction angiography(DSA) and feasible endovascular treatment were performed simultaneously.The source images were subtracted from mask images and transferred to computer workstation.All images were subsequently post-processed using three-dimensional reconstruction.3D-TOF MRA images and DSA images were compared for demonstration of the aneurysm,its neck and relationship with parent artery and the usefulness for endovascular treatment evaluation.Results:There were 27 cases with 20 intracranial aneurysms.The sensitivity,specitifity and accuracy of 3D-TOF MRA were 95%,80%,90%,respectively.Aneurysms and its neck depiction at 3D-TOF MRA were significantly better than those at DSA,especially for aneurysms adjacent to the cavernous sinus and near the PICA of the vertebral artery.3D-TOF MRA could guide neurosurgeons to the desired DSA projection,and help them to make plan for interventional or surgical treatment in advance.But the diagnosis should be very carefully made for smallaneurysms located in the periphery and the arterial bifurcation.Conclution：3D-TOF MRA is a fast,noninvasive and efficient technique for diagnosing intracranial aneurysms.Its three dimensional information is help for DSA demonstration and treatment planning.Any uncertain diagnosis requires DSA confirmation.
, 百拇医药
【Key words】Celebral aneurysm；Magnetic resonance angiography；Image processing
颅内动脉瘤(celebral aneurysm)是严重危害人类健康的脑血管病之一，蛛网膜下腔出血有50%～70%为脑动脉瘤破裂所引起[1]，对能度过最初出血危险期的病人，动脉瘤再出血是致死的重要因素，因此，尽早发现和治疗引起蛛网膜下腔出血(SAH)的颅内动脉瘤是挽救这些病人生命的关键。常规血管造影被认为是诊断颅内动脉瘤的“金标准”，但考虑到其有创、耗时，所用的对比剂有肾毒性并有发生不良反应的危险[2]，无创性影像检查越来越受到临床关注。
1 资料与方法
1.1 一般资料：对27例临床高度怀疑有颅内动脉瘤的病人行3D-TOF磁共振血管摄影术(MRA)检查，随后行数控减影血管造影术(DSA)检查及可行的血管内栓塞治疗。男13例，女14例，平均年龄46岁( 20～77岁)。27例中，急性或亚急性SAH 18例，曾有SAH史3例，脑内出血1例，动眼神经麻痹5例，剧烈头痛1例，外伤性鼻出血1例，突发偏侧肢体无力1例。
, 百拇医药
1.2 检查方法：3D-TOF MRA检查使用Siemens Magnetom Trio Tim 3.0T磁共振扫描仪，头线圈，仰卧位，FOV：220 mm，层厚：0.65 mm，层间隔:-35%，TR 22ms，TE 3.81 ms，距阵512×372，分6块，每块40层。
图像后处理及分析在SINGO工作站上用实时三维容积显示(RT 3D volume rendering)技术，主要用表面容积显示(surface volume rendering，SVR)，SVR透明化所得的类似DSA像，最大密度投影(Maximum intensity projection，MIP)(三者间互换容易)，同时可行多平面重建(multiplanner reconstruction，MPR)及参照原始图像，每个病人的图像后处理时间15～20分钟。由放射科医师及神经介入科医师共同阅片，对形成的颅内血管多角度观察，评价成像质量；对有动脉瘤者，观察动脉瘤位置、方向、形态、大小及解剖细节，充分显示瘤颈，了解动脉瘤与载瘤动脉及周围血管的关系；评价不同后处理图像对动脉瘤、瘤颈及与载瘤动脉关系的显示，并与常规DSA比较。, 百拇医药(许云飞 尉传社 王峥超 刘 文)
【关键词】脑动脉瘤；磁共振血管造影术；图像处理
, http://www.100md.com 文章编号：1009-5519(2007)23-3480-03 中图分类号：R445 文献标识码：A
The diagnostic value of3.0T three-dimensional time of flight magnetic resonance angiography in intracranial aneurysms
XU Yun-fei,WEI Chuan-she，WANG Zheng-chao,et al.
(Department of Radiology,The Affliated Hospital of Jiangsu University，Zhenjiang 212001，China)
【Abstract】Objective：To evaluate the diagnostic value of 3.0T three-dimensional time of flight magnetic resonance angiography(3D-TOF MRA) in intracranial aneurysms.Methods:3D-TOF MRA was performed in 27 patients highly suspected with intracranial aneurysms.Then conventionl digital subtraction angiography(DSA) and feasible endovascular treatment were performed simultaneously.The source images were subtracted from mask images and transferred to computer workstation.All images were subsequently post-processed using three-dimensional reconstruction.3D-TOF MRA images and DSA images were compared for demonstration of the aneurysm,its neck and relationship with parent artery and the usefulness for endovascular treatment evaluation.Results:There were 27 cases with 20 intracranial aneurysms.The sensitivity,specitifity and accuracy of 3D-TOF MRA were 95%,80%,90%,respectively.Aneurysms and its neck depiction at 3D-TOF MRA were significantly better than those at DSA,especially for aneurysms adjacent to the cavernous sinus and near the PICA of the vertebral artery.3D-TOF MRA could guide neurosurgeons to the desired DSA projection,and help them to make plan for interventional or surgical treatment in advance.But the diagnosis should be very carefully made for smallaneurysms located in the periphery and the arterial bifurcation.Conclution：3D-TOF MRA is a fast,noninvasive and efficient technique for diagnosing intracranial aneurysms.Its three dimensional information is help for DSA demonstration and treatment planning.Any uncertain diagnosis requires DSA confirmation.
, 百拇医药
【Key words】Celebral aneurysm；Magnetic resonance angiography；Image processing
颅内动脉瘤(celebral aneurysm)是严重危害人类健康的脑血管病之一，蛛网膜下腔出血有50%～70%为脑动脉瘤破裂所引起[1]，对能度过最初出血危险期的病人，动脉瘤再出血是致死的重要因素，因此，尽早发现和治疗引起蛛网膜下腔出血(SAH)的颅内动脉瘤是挽救这些病人生命的关键。常规血管造影被认为是诊断颅内动脉瘤的“金标准”，但考虑到其有创、耗时，所用的对比剂有肾毒性并有发生不良反应的危险[2]，无创性影像检查越来越受到临床关注。
1 资料与方法
1.1 一般资料：对27例临床高度怀疑有颅内动脉瘤的病人行3D-TOF磁共振血管摄影术(MRA)检查，随后行数控减影血管造影术(DSA)检查及可行的血管内栓塞治疗。男13例，女14例，平均年龄46岁( 20～77岁)。27例中，急性或亚急性SAH 18例，曾有SAH史3例，脑内出血1例，动眼神经麻痹5例，剧烈头痛1例，外伤性鼻出血1例，突发偏侧肢体无力1例。
, 百拇医药
1.2 检查方法：3D-TOF MRA检查使用Siemens Magnetom Trio Tim 3.0T磁共振扫描仪，头线圈，仰卧位，FOV：220 mm，层厚：0.65 mm，层间隔:-35%，TR 22ms，TE 3.81 ms，距阵512×372，分6块，每块40层。
图像后处理及分析在SINGO工作站上用实时三维容积显示(RT 3D volume rendering)技术，主要用表面容积显示(surface volume rendering，SVR)，SVR透明化所得的类似DSA像，最大密度投影(Maximum intensity projection，MIP)(三者间互换容易)，同时可行多平面重建(multiplanner reconstruction，MPR)及参照原始图像，每个病人的图像后处理时间15～20分钟。由放射科医师及神经介入科医师共同阅片，对形成的颅内血管多角度观察，评价成像质量；对有动脉瘤者，观察动脉瘤位置、方向、形态、大小及解剖细节，充分显示瘤颈，了解动脉瘤与载瘤动脉及周围血管的关系；评价不同后处理图像对动脉瘤、瘤颈及与载瘤动脉关系的显示，并与常规DSA比较。, 百拇医药(许云飞 尉传社 王峥超 刘 文)