Rengier Fabian, Geisbüsch Philipp, Vosshenrich Rolf, Müller-Eschner Matthias, Karmonik Christof, Schoenhagen Paul, von Tengg-Kobligk Hendrik, Partovi Sasan
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany, and Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany.
Vasa. 2013 Nov;42(6):395-412. doi: 10.1024/0301-1526/a000309.
Over the last two decades, imaging of the aorta has undergone a clinically relevant change. As part of the change non-invasive imaging techniques have replaced invasive intra-arterial digital subtraction angiography as the former imaging gold standard for aortic diseases. Computed tomography (CT) and magnetic resonance imaging (MRI) constitute the backbone of pre- and postoperative aortic imaging because they allow for imaging of the entire aorta and its branches. The first part of this review article describes the imaging principles of CT and MRI with regard to aortic disease, shows how both technologies can be applied in every day clinical practice, offering exciting perspectives. Recent CT scanner generations deliver excellent image quality with a high spatial and temporal resolution. Technical developments have resulted in CT scan performed within a few seconds for the entire aorta. Therefore, CT angiography (CTA) is the imaging technology of choice for evaluating acute aortic syndromes, for diagnosis of most aortic pathologies, preoperative planning and postoperative follow-up after endovascular aortic repair. However, radiation dose and the risk of contrast induced nephropathy are major downsides of CTA. Optimisation of scan protocols and contrast media administration can help to reduce the required radiation dose and contrast media. MR angiography (MRA) is an excellent alternative to CTA for both diagnosis of aortic pathologies and postoperative follow-up. The lack of radiation is particularly beneficial for younger patients. A potential side effect of gadolinium contrast agents is nephrogenic systemic fibrosis (NSF). In patients with high risk of NSF unenhanced MRA can be performed with both ECG- and breath-gating techniques. Additionally, MRI provides the possibility to visualise and measure both dynamic and flow information.
在过去二十年中，主动脉成像技术发生了具有临床意义的变化。作为这种变化的一部分，非侵入性成像技术已取代侵入性动脉内数字减影血管造影，成为主动脉疾病的先前成像金标准。计算机断层扫描（CT）和磁共振成像（MRI）构成了主动脉术前和术后成像的支柱，因为它们能够对整个主动脉及其分支进行成像。这篇综述文章的第一部分描述了CT和MRI在主动脉疾病方面的成像原理，展示了这两种技术如何应用于日常临床实践，提供了令人兴奋的前景。最新一代的CT扫描仪具有出色的图像质量，空间和时间分辨率都很高。技术发展使得能够在几秒钟内完成整个主动脉的CT扫描。因此，CT血管造影（CTA）是评估急性主动脉综合征、诊断大多数主动脉病变、术前规划以及血管腔内主动脉修复术后随访的首选成像技术。然而，辐射剂量和造影剂肾病风险是CTA的主要缺点。优化扫描方案和造影剂给药可以帮助降低所需的辐射剂量和造影剂用量。磁共振血管造影（MRA）对于主动脉病变的诊断和术后随访是CTA的绝佳替代方法。无辐射对于年轻患者尤为有益。钆造影剂的一个潜在副作用是肾源性系统性纤维化（NSF）。对于NSF高风险患者，可以采用心电图门控和呼吸门控技术进行非增强MRA。此外，MRI还能够可视化和测量动态及血流信息。
