Di Cesare E, Giordano A V, Cerone G, De Remigis F, Deusanio G, Masciocchi C
Department of Radiology, University of L'Aquila, Ospedale di Coppito, Italy.
Int J Card Imaging. 2000 Jun;16(3):135-47. doi: 10.1023/a:1006404824873.
To verify the diagnostic potentialities of conventional magnetic resonance imaging (MRI), breath-hold 3D contrast enhanced MR angiography (C3D MRA) and transesophageal echocardiography (TEE) in patients surgically treated for type A aortic dissection.
Twenty-nine patients (21 males and 8 females), surgically treated for type A aortic dissection, were evaluated with MRI using a 1.5 T (GE Horizon Echospeed 8.2) with standard gated SE sequences and breath-hold 3D fast SPGR after intravenous Gd injection (0.2 mmol/kg). 3D MIP reconstruction was obtained. TEE evaluation was performed with a HP 2000 system and a biplane 5 MHz probe. The sizes of aortic root, distal anastomosis, descending aorta and periprosthetic thickening were measured. Regional false lumen and aortic branch involvement were also evaluated.
Concordance among TEE, conventional MRI and C3D MRA was observed in the evaluation of aortic root (MRI vs. C3D MRA r = 0.93; MRI vs. TEE r = 0.84; C3D MRA vs. TEE r = 0.84) and descending aorta (r = 0.94, 0.91 and 0.92, respectively). The interobserver variability was also very low. Inadequate agreement was observed for distal anastomosis. C3D MRA was inadequate in the evaluation of periprosthetic thickening; r = 0.73 was obtained between MRI and TEE. For qualitative data: TEE was inadequate in the evaluation of the abdominal aorta and branches. C3D MRA depicted supra-aortic vessel involvement in more cases than the other techniques.
C3D MRA is a fast and accurate technique in the evaluation of the endoluminal alterations and involvement of the aortic branches. Conventional MRI allows a direct evaluation of the aortic wall and periaortic tissue. TEE is less accurate in the evaluation of aortic branches and abdominal aorta.
验证传统磁共振成像（MRI）、屏气三维对比增强磁共振血管造影（C3D MRA）和经食管超声心动图（TEE）在接受A型主动脉夹层手术治疗患者中的诊断潜力。
对29例接受A型主动脉夹层手术治疗的患者（21例男性，8例女性）进行评估，使用1.5T（GE Horizon Echospeed 8.2）磁共振成像仪，采用标准门控SE序列，并在静脉注射钆剂（0.2 mmol/kg）后进行屏气三维快速扰相梯度回波序列成像。获得三维最大强度投影（MIP）重建图像。使用HP 2000系统和双平面5MHz探头进行TEE评估。测量主动脉根部、远端吻合口、降主动脉和人工血管周围增厚的大小。还评估了局部假腔和主动脉分支受累情况。
在主动脉根部（MRI与C3D MRA的r值为0.93；MRI与TEE的r值为0.84；C3D MRA与TEE的r值为0.84）和降主动脉（r值分别为0.94、0.91和0.92）的评估中，观察到TEE、传统MRI和C3D MRA之间具有一致性。观察者间的变异性也非常低。在远端吻合口方面观察到一致性不足。C3D MRA在人工血管周围增厚的评估中存在不足；MRI与TEE之间的r值为0.73。对于定性数据：TEE在腹主动脉及其分支的评估中存在不足。C3D MRA显示主动脉弓上血管受累的病例比其他技术更多。
C3D MRA是评估主动脉腔内改变和主动脉分支受累的快速准确技术。传统MRI可直接评估主动脉壁和主动脉周围组织。TEE在主动脉分支和腹主动脉的评估中准确性较低。
