van den Berg R, Wasser M N, van Gils A P, van der Mey A G, Hermans J, van Buchem M A
Department of Radiology, Leiden University Medical Center, The Netherlands.
AJNR Am J Neuroradiol. 2000 Jan;21(1):162-70.
MR angiography of the head and neck region has been studied widely, but few studies have been performed concerning the efficacy of MR angiography for the identification of the specific vascular supply of the highly vascular head and neck paragangliomas. In this study, we compared three MR angiography techniques with respect to visualization of branch arteries in the neck and identification of tumor feeders in patients with paragangliomas.
Fourteen patients with 29 paragangliomas were examined at 1.5 T using 3D phase-contrast (PC), 2D time-of-flight (2D TOF), and multi-slab 3D TOF MR angiography. In the first part of the study, two radiologists independently evaluated the visibility of first-, second-, and third-order branch arteries in the neck. In the second part of the study, the number of feeding arteries for every paraganglioma was determined and compared with digital subtraction angiography (DSA), the standard of reference in this study.
Three-dimensional TOF angiography was superior to the other MR angiography techniques studied (P < .05) for depicting branch arteries of the external carotid artery in the neck, but only first- and second-order vessels were reliably shown. DSA showed a total of 78 feeding arteries in the group of patients with 29 paragangliomas, which was superior to what was revealed by all MR angiography techniques studied. More tumor feeders were identified with 3D TOF and 2D TOF angiography than with 3D PC MR angiography (P < .05), with a sensitivity/specificity of 61%/98%, 54%/95%, and 31%/95%, respectively. Sensitivity was lowest for carotid body tumors.
Compared with intra-arterial DSA, the 3D TOF MR angiography technique was superior to 3D PC and 2D TOF MR angiography for identifying the first- and second-order vessels in the neck. With 3D TOF angiography, more tumor feeders were identified than with the other MR angiography techniques studied. The sensitivity of MR angiography, however, is not high enough to reveal important vascularization. The sensitivity of MR angiography is too low to replace DSA, especially in the presence of carotid body tumors.
头颈部区域的磁共振血管造影（MR angiography）已得到广泛研究，但针对MR血管造影在识别高血运头颈部副神经节瘤特定血管供应方面的有效性研究较少。在本研究中，我们比较了三种MR血管造影技术在显示颈部分支动脉以及识别副神经节瘤患者肿瘤供血动脉方面的情况。
对14例患有29个副神经节瘤的患者在1.5T条件下采用三维相位对比（PC）、二维时间飞跃（2D TOF）和多层面三维时间飞跃MR血管造影进行检查。在研究的第一部分，两名放射科医生独立评估颈部一级、二级和三级分支动脉的可视性。在研究的第二部分，确定每个副神经节瘤的供血动脉数量，并与数字减影血管造影（DSA，本研究中的参考标准）进行比较。
在显示颈部颈外动脉的分支动脉方面，三维时间飞跃血管造影优于所研究的其他MR血管造影技术（P <.05），但仅能可靠显示一级和二级血管。DSA显示29个副神经节瘤患者组共有78条供血动脉，优于所研究的所有MR血管造影技术所显示的情况。与三维相位对比MR血管造影相比，三维时间飞跃和二维时间飞跃血管造影识别出的肿瘤供血动脉更多（P <.05），其敏感度/特异度分别为61%/98%、54%/95%和31%/95%。颈动脉体瘤的敏感度最低。
与动脉内DSA相比，三维时间飞跃MR血管造影技术在识别颈部一级和二级血管方面优于三维相位对比和二维时间飞跃MR血管造影。采用三维时间飞跃血管造影时，识别出的肿瘤供血动脉比所研究的其他MR血管造影技术更多。然而，MR血管造影的敏感度不足以显示重要的血管化情况。MR血管造影的敏感度过低，无法替代DSA，尤其是在存在颈动脉体瘤的情况下。
