Pfluger T, Czekalla R, Hundt C, Schubert M, Graubner U, Leinsinger G, Scheck R, Hahn K
Department of Radiology, Klinikum Innenstadt, Ludwig-Maximilians-University of Munich, Germany.
AJR Am J Roentgenol. 1999 Jul;173(1):103-8. doi: 10.2214/ajr.173.1.10397108.
Involvement of renal vessels and the inferior vena cava (IVC) plays a decisive role during operative planning for removal of abdominal masses in pediatric patients. Advantages and limitations of MR angiography and color Doppler sonography for determining these factors were evaluated.
MR angiography and color Doppler sonography were performed preoperatively in 42 neonates, infants, and children with abdominal masses and were compared with spin-echo MR imaging and with surgical findings. Variables evaluated were anatomic variants, vessel displacement, patency of vessels, collateral circulation, and intravascular tumor extension. Quality of vessel visualization was assessed in vessels not affected by tumor.
In 88% of unaffected renal vessels, the entire vessel course could be visualized on MR angiography compared with 58% on color Doppler sonography and 43% on spin-echo MR imaging. In four of nine cases, color Doppler sonography revealed an accessory renal artery, whereas MR angiography revealed these variants in seven of nine cases. MR angiography showed 79% and color Doppler sonography 66% of displaced vessels. Unlike MR angiography, color Doppler sonography did not reveal five stenotic renal veins because they could not be completely imaged. In two cases, however, MR angiography falsely indicated an occlusion of the IVC, whereas color Doppler sonography showed residual flow.
Anatomic variants, vessel displacement, collateral circulation, and neoplastic vessel infiltration were revealed more accurately by MR angiography than by color Doppler sonography. In cases in which patency of the IVC is unclear on MR angiography, color Doppler sonography should also be performed.
肾血管及下腔静脉（IVC）受累情况在小儿腹部肿块切除手术规划中起决定性作用。本研究评估了磁共振血管造影（MR angiography）和彩色多普勒超声检查在确定这些因素方面的优势与局限性。
对42例患有腹部肿块的新生儿、婴儿及儿童术前进行了MR血管造影和彩色多普勒超声检查，并与自旋回波磁共振成像及手术结果进行比较。评估的变量包括解剖变异、血管移位、血管通畅情况、侧支循环及血管内肿瘤延伸情况。在未受肿瘤影响的血管中评估血管可视化质量。
在88%未受影响的肾血管中，MR血管造影能够显示整个血管走行，相比之下，彩色多普勒超声检查为58%，自旋回波磁共振成像为43%。在9例中的4例中，彩色多普勒超声检查发现了副肾动脉，而MR血管造影在9例中的7例中发现了这些变异。MR血管造影显示了79%的移位血管，彩色多普勒超声检查显示了66%。与MR血管造影不同，彩色多普勒超声检查未发现5条狭窄的肾静脉，因为它们无法完全成像。然而，在2例中，MR血管造影错误地显示下腔静脉闭塞，而彩色多普勒超声检查显示有残余血流。
与彩色多普勒超声检查相比，MR血管造影能更准确地显示解剖变异、血管移位、侧支循环及肿瘤血管浸润情况。在MR血管造影显示下腔静脉通畅情况不明的病例中，也应进行彩色多普勒超声检查。
