Warren D J, Hoggard N, Walton L, Radatz M W, Kemeny A A, Forster D M, Wilkinson I D, Griffiths P D
Section of Academic Radiology, University of Sheffield, England.
Neurosurgery. 2001 May;48(5):973-82; discussion 982-3.
To investigate the potential of novel magnetic resonance (MR) angiographic techniques for the assessment of cerebral arteriovenous malformations.
Forty patients who were about to undergo stereotactic radiosurgery were prospectively recruited. Three-dimensional, sliding-slab interleaved ky (SLINKY), time-of-flight acquisition was performed, as was a dynamic MR digital subtraction angiography (DSA) procedure in which single thick slices (6-10 cm) were obtained using a radiofrequency spoiled Fourier-acquired steady-state sequence (1 image/s). Sixty images were acquired, in two or three projections, during passage of a 6- to 10-ml bolus of gadolinium chelate. Subtraction and postprocessing were performed, and images were viewed in an inverted cine mode. SLINKY time-of-flight acquisition was repeated after the administration of gadolinium. Routine stereotactic conventional catheter angiography was performed after MR imaging. All images were assessed (in a blinded randomized manner) for Spetzler-Martin grading and determination of associated vascular pathological features.
Forty-one arteriovenous malformations were assessed in 40 patients. Contrast-enhanced (CE) SLINKY MR angiography was the most consistent MR imaging technique, yielding a 95% correlation with the Spetzler-Martin classification defined by conventional catheter angiography; MR DSA exhibited 90% agreement, and SLINKY MR angiography exhibited 81% agreement. CE SLINKY MR angiography provided improved nidus delineation, compared with non-CE SLINKY MR angiography. Dynamic information from MR DSA significantly improved the observation of early-draining veins and associated aneurysms.
CE SLINKY MR angiographic assessment of cerebral arteriovenous malformations offers significant advantages, compared with the use of non-CE SLINKY MR angiography, including improved nidus demonstration. MR DSA shows promise as a noninvasive method for dynamic angiography but is presently restricted by limitations in both temporal and spatial resolution.
探讨新型磁共振（MR）血管造影技术在评估脑动静脉畸形方面的潜力。
前瞻性招募了40例即将接受立体定向放射外科治疗的患者。进行了三维、滑动板交错ky（SLINKY）、飞行时间采集，以及动态MR数字减影血管造影（DSA）程序，其中使用射频扰相傅里叶采集稳态序列（每秒1幅图像）获得单个厚层（6 - 10厘米）图像。在注入6至10毫升钆螯合物的过程中，以两个或三个投影采集60幅图像。进行减影和后处理，并以反转电影模式查看图像。注入钆后重复SLINKY飞行时间采集。MR成像后进行常规立体定向导管血管造影。所有图像均以盲法随机方式进行评估，以确定Spetzler - Martin分级并确定相关血管病理特征。
40例患者共评估了41个动静脉畸形。对比增强（CE）SLINKY MR血管造影是最一致的MR成像技术，与传统导管血管造影定义的Spetzler - Martin分类的相关性为95%；MR DSA的一致性为90%，SLINKY MR血管造影的一致性为81%。与非CE SLINKY MR血管造影相比，CE SLINKY MR血管造影能更好地勾勒畸形团。MR DSA的动态信息显著改善了对早期引流静脉和相关动脉瘤的观察。
与使用非CE SLINKY MR血管造影相比，CE SLINKY MR血管造影对脑动静脉畸形的评估具有显著优势，包括更好地显示畸形团。MR DSA作为一种无创动态血管造影方法显示出前景，但目前受时间和空间分辨率的限制。
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