采用时间分辨 3.0TMR 血管造影术对 Adamkiewicz 动脉进行术前定位。

Presurgical localization of the artery of Adamkiewicz with time-resolved 3.0-T MR angiography.

机构信息

Department of Radiology, University of Wisconsin, 600 Highland Ave, CSC E1/374, Madison, WI 53792, USA.

出版信息

Radiology. 2010 Jun;255(3):873-81. doi: 10.1148/radiol.10091304.

DOI:10.1148/radiol.10091304

PMID:20501724

Abstract

PURPOSE

To evaluate the use of time-resolved magnetic resonance (MR) angiography in the presurgical localization of the artery of Adamkiewicz prior to reimplantation of the feeding intercostal artery, lumbar artery, or both during aortic aneurysm repair.

MATERIALS AND METHODS

This institutional review board-approved retrospective study included 68 patients (36 men, 32 women) who underwent time-resolved spinal MR angiography (0.2 mmol per kilogram of body weight gadobenate dimeglumine administered at a rate of 2.0 mL per second) performed with a 3.0-T imager with a dedicated eight-element spine coil. Images were reviewed at a three-dimensional workstation by two experienced radiologists in consensus. The artery of Adamkiewicz was identified, and the location of the feeding intercostal and/or lumbar artery was ascertained by using a five-point confidence index (scores ranged from 1 to 5). The phases in which the artery of Adamkiewicz, aorta, and great anterior radiculomedullary vein (GARV) demonstrated peak enhancement were also recorded.

RESULTS

The artery of Adamkiewicz and the location of the feeding intercostal and/or lumbar artery were identified with high confidence in 60 (88%) of the 68 patients. Origins of the artery of Adamkiewicz were on the left side of the body in 65% of patients and on the right side in 35%. The level of origin ranged from the T6 neuroforamina to the L1 neuroforamina. The arrival of contrast material was highly variable in this patient population, which had substantial aortic disease. The highest signal intensity in the aorta, artery of Adamkiewicz, and GARV occurred a mean of 55 seconds (range, 27-99 seconds; 95% confidence interval [CI] 51, 58), 72 seconds (range, 38-110 seconds; 95% CI: 68, 76), and 95 seconds (range, 46-156 seconds; 95% CI: 89, 101) after contrast material administration, respectively.

CONCLUSION

The artery of Adamkiewicz and the anterior spinal artery can be identified and differentiated from the GARV even in patients with substantially altered hemodynamics by using time-resolved 3.0-T MR angiography.

摘要

目的

在主动脉瘤修复过程中，于再植入供养肋间动脉、腰动脉或两者时，评估术前使用时间分辨磁共振血管造影术（TR-MRA）对节段动脉定位的作用。

材料与方法

本研究经机构审查委员会批准，回顾性分析了 68 例患者（男 36 例，女 32 例）的资料，这些患者均在 3.0T 成像仪上接受时间分辨脊髓 MRA 检查（0.2mmol/kg 体质量二甲基葡胺钆，以 2.0ml/s 的速度注入），采用专用八通道脊柱线圈。由 2 名有经验的放射科医生在三维工作站上对图像进行共识评估。通过使用五分制置信指数（评分为 1 ～ 5 分）确定节段动脉，确定供养肋间和/或腰动脉的位置。记录节段动脉、主动脉和大前根髓静脉（GARV）达到峰值强化的相位。

结果

在 68 例患者中，有 60 例（88%）高度确信识别出节段动脉和供养肋间及/或腰动脉的位置。节段动脉起源于左侧身体的占 65%，起源于右侧身体的占 35%。起源水平从 T6 脊神经孔到 L1 脊神经孔。在存在严重主动脉疾病的患者中，对比剂到达的时间高度可变。在主动脉、节段动脉和 GARV 中，信号强度最高出现在平均 55 秒（范围，27 ～ 99 秒；95%置信区间[CI]：51 ，58）、72 秒（范围，38 ～ 110 秒；95%CI：68 ，76）和 95 秒（范围，46 ～ 156 秒；95%CI：89 ，101）后。