Gupta Atul, Grünhagen Thijs
Department of Interventional Radiology, Paoli Hospital, 255 W. Lancaster Ave., Paoli, PA 19301.
J Vasc Interv Radiol. 2013 Nov;24(11):1690-7. doi: 10.1016/j.jvir.2013.07.013. Epub 2013 Aug 28.
To assess the feasibility of live magnetic resonance (MR) angiography roadmapping guidance for uterine artery (UA) embolization (UAE) for fibroid tumors.
Twenty patients underwent UAE with live MR angiographic roadmapping. The pre-acquired MR angiography scan was coregistered with the live intraprocedural fluoroscopy stream to create a visual roadmap to direct the microcatheter during UAE. Patient radiation dose, as measured by dose-area product (DAP), procedure time, contrast medium volume, and fluoroscopy time, was recorded. For the first 10 patients, an additional parameter of contrast medium volume needed to catheterize each UA was recorded.
In all 20 patients (40 UAs), the MR angiography overlay on live fluoroscopy was accurate and allowed for successful catheterization of the UA, resulting in a technical success rate of 100%. In the subset of the initial 20 UAs (ie, the first 10 patients) in which this data point was recorded, 17 (85%) were successfully catheterized with no iodinated contrast medium at all, by purely relying on the MR angiography roadmap. Mean procedure time was 45 minutes (range, 30-99 min), mean contrast agent dose was 75 mL (range, 46-199 mL), and mean DAP was 155 Gy · cm(2) (range, 37-501 Gy · cm(2)).
Live MR angiographic roadmapping is feasible and accurate for catheter guidance during UAE.
评估实时磁共振(MR)血管造影路线图引导下子宫肌瘤子宫动脉(UA)栓塞术(UAE)的可行性。
20例患者接受了实时MR血管造影路线图引导下的UAE。将预先采集的MR血管造影扫描与实时术中透视影像进行配准,以创建视觉路线图,在UAE期间引导微导管。记录患者的辐射剂量(用剂量面积乘积(DAP)衡量)、手术时间、造影剂用量和透视时间。对于前10例患者,记录了导管插入每侧UA所需的造影剂用量这一额外参数。
在所有20例患者(40条UA)中,实时透视上的MR血管造影叠加准确,使UA成功插管,技术成功率为100%。在记录了该数据点的最初20条UA(即前10例患者)亚组中,17条(85%)仅依靠MR血管造影路线图成功插管,完全未使用碘化造影剂。平均手术时间为45分钟(范围30 - 99分钟),平均造影剂剂量为75毫升(范围46 - 199毫升),平均DAP为155 Gy·cm²(范围37 - 501 Gy·cm²)。
实时MR血管造影路线图在UAE期间用于导管引导是可行且准确的。