三维增强MR血管成像诊断脑动静脉畸形的价值  

Three-dimensional contrast-enhanced MR angiography in diagnosis of cerebral arteriovenous malformation

作　　者：刘崎[1] 陆建平[1] 王飞[1] 王莉[1] 田建明[1] 金爱国[1] 曾浩[1] 

机构地区：[1]第二军医大学附属长海医院放射科,上海200433

出　　处：《中华放射学杂志》2006年第8期833-836,共4页Chinese Journal of Radiology

摘　　要：目的评价三维增强MR血管成像(3D CE MRA)及相关MRI对脑动静脉畸形(AVM)的诊断价值。方法22例脑AVM患者行头颅MRI及3D CE MRA检查,17例同时行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22例中19例MRI显示脑AVM特征性流空血管影,3D CE MRA显示明确异常血管团、供血动脉及引流静脉。病灶均位于幕上,单叶13例,跨叶3例,大脑深部3例；单支供血动脉9例,联合供血10例；引流静脉入上矢状窦6例,至大脑深部8例,向脑表面及脑深部均有引流5例。14例3D CE MRA与DSA比较,DSA显示供血动脉37支,引流静脉25支。3D CE MRA结合MRI对异常血管团的定位及立体显示优于DSA,但在一些细节显示上不如DSA；3D CE MRA对供血动脉的显示率为78．4%(29/37),对引流静脉的显示率为84．0%(21/25)。另外,3例DSA发现＜1 cm的微小异常血管,但3D CE MRA未见,MRI仅表现为脑内出血灶。结论3D CE MRA结合MRI对脑AVM能无创性准确定位、定性,并可显示其结构组成,可作为临床高度怀疑脑AVM患者的首选影像检查方法。但在显示某些细节及＜1 cm的微小AVM方面仍需DSA检查。Objective To evaluate the value of three-dimensional contrast-enhanced angiography （3D CE MRA） and MRI in the diagnosis and delineation of cerebral arteriovenous malformation （AVM）. Methods Twenty-two cases of cerebral AVM examined by MRI and 3D CE MRA. DSA was performed in 17 cases. A three-dimensional fast low angle shot （3D FLASH） was used for 3D CE MRA with Gd-DTPA dosage of 0. 2 mmol per kilogram for body weight. The source images were subtracted from mask images and transferred to computer workstation using three-dimensional reconstruction. Results Among 22 cases, 19 showed typical AVM ＂flow void＂ signal on MR images. 3D CE MRA clearly displayed the nidus, feeding artery and draining vein. All of the foci were above the cerebellum tentorium. 13 located within one lobe, 3 exceeded one lobe and 3 situated in the deep of cerebrum. Feeding arteries were derived from single artery in 9 cases, and mixed supply in 10 cases. Draining veins diverted to sagittal sinus and/or sigmoid sinus in 6, deep cerebral veins in 8 and mixed in 5. In the 14 cases examined by both DSA and 3D CE MRA, 3D CE MRA was superior to DSA in three-dimensional demonstration of the nidus, but inferior to DSA in demonstration of some details. 3D CE MRA depicted 78.4% feeding arteries and 84. 0% draining veins in addition, tiny pathologic blood vessels smaller than 1 centimeter were detected by DSA, but could not be found by 3D CE MRA and were only shown as hemorrhage lesions on MR images in 3 cases. Conclusion As a non-invasive technique, 3D CE MRA combined with MRI is accurate in diagnosis and localization of cerebral AVM, and should be used as the first choice for those clinically suspected of AVM. But DSA remains needed for demonstration of details and tiny AVM.

关 键 词：颅内动静脉畸形 磁共振血管造影术 图像处理 计算机辅助 

分 类 号：R445.2[医药卫生—影像医学与核医学]