Lookstein Robert A, Goldman Jeffrey, Pukin Lev, Marin Michael L
Department of Interventional Radiology, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA.
J Vasc Surg. 2004 Jan;39(1):27-33. doi: 10.1016/j.jvs.2003.09.035.
Several types of endoleaks have been described, each with different methods of treatment. Conventional arteriography is widely regarded as the gold standard for the classification of endoleaks. Recently, faster magnetic resonance gradients have allowed for rapid data acquisition and review of vascular studies as a real-time continuous angiogram (time resolved magnetic resonance angiography [TR-MRA]). This study was performed to compare the findings of TR-MRA with conventional angiography for the characterization of endoleaks.
Between June 2002 and June 2003, 12 patients with documented endoleaks following endovascular repair of aortic aneurysms (10 abdominal and two thoracic) underwent TR-MRA to identify and characterize the endoleak. All patients had nitinol-based aortic stent grafts. MRA was performed on a 1.5-Tesla magnet (Sonata class; Siemens Medical Systems, Iselin, NJ). The TR-MRA studies were reviewed under continuous observation as a "cine MR angiogram." These MRA data sets were used to classify the endoleaks into types 1 through 3. The patients underwent conventional angiography following the MRA to confirm the findings and to plan treatment. The MRA findings were compared with the findings made at conventional arteriography.
TR-MRA identified seven patients with type 1 leaks, including four proximal and three distal. Four patients had type 2 leaks, including two arising from the inferior mesenteric artery and two from an iliolumbar artery. One patient had a type 3 leak. Conventional angiography confirmed the type of endoleak in all 12 patients.
These initial results demonstrate TR-MRA to be an effective noninvasive method for classifying endoleaks. This technique may allow for screening of patients with endoleaks to identify those requiring urgent repair.
已描述了几种类型的内漏，每种类型都有不同的治疗方法。传统血管造影术被广泛认为是内漏分类的金标准。最近，更快的磁共振梯度技术使得能够快速采集数据并将血管研究作为实时连续血管造影（时间分辨磁共振血管造影[TR-MRA]）进行回顾。本研究旨在比较TR-MRA与传统血管造影术在内漏特征描述方面的结果。
在2002年6月至2003年6月期间，12例腹主动脉瘤（10例腹主动脉瘤和2例胸主动脉瘤）血管内修复术后有记录的内漏患者接受了TR-MRA检查，以识别和表征内漏。所有患者均使用镍钛合金材质的主动脉支架移植物。MRA检查在1.5特斯拉磁体（Sonata型；西门子医疗系统公司，新泽西州伊斯林）上进行。TR-MRA研究作为“电影磁共振血管造影”在连续观察下进行回顾。这些MRA数据集用于将内漏分为1至3型。患者在MRA检查后接受传统血管造影以确认结果并制定治疗方案。将MRA结果与传统血管造影的结果进行比较。
TR-MRA识别出7例1型内漏患者，包括4例近端内漏和3例远端内漏。4例患者有2型内漏，包括2例源于肠系膜下动脉和2例源于髂腰动脉。1例患者有3型内漏。传统血管造影术在所有12例患者中均确认了内漏类型。
这些初步结果表明TR-MRA是一种有效的非侵入性内漏分类方法。该技术可能有助于筛查内漏患者，以识别那些需要紧急修复的患者。
