Dipartimento di Radiologia, IRCCS Istituto Clinico Humanitas, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
Radiol Med. 2015 May;120(5):407-12. doi: 10.1007/s11547-014-0462-4. Epub 2014 Oct 28.
This paper presents a new magnetic resonance angiography (MRA) protocol for the evaluation of thoracic outlet syndrome (TOS) that allows for a separate assessment of veins and arteries while using a single, simultaneous and bilateral (SB-MRA) single contrast injection, valid for both abduction and adduction acquisitions.
From 2009 to 2013 we performed 38 MRA studies for clinically suspected TOS (13 M, 25 F; mean age, 35.9 years; σ = 11.13). Twin peripheral 20G intravenous catheters were placed in a cubital vein in both arms and connected to a single power injector by two lines joined with a connector. A 3T MR system with a wide gantry was used. Two groups of four radiologists assessed all the images. Group A judged the full examinations, Group B had only the late acquisitions. Differences were evaluated using the Chi square test. TOS was confirmed only after integration with the clinical history.
Seventeen (45 %) patients were diagnosed with predominant venous TOS (VTOS), nine (24 %) with predominant arterial TOS (ATOS) and 12 (32 %) had an indeterminate or nonvascular condition. Group A radiologists identified significantly more VTOS than group B (p = 0.049). Interobserver agreement was very high.
SB-MRA is a safe and reliable protocol for the study of TOS. It provides a supplementary early acquisition that allows for separate assessment of veins and arteries, permits the investigation of the collateral venous flow with a single injection of contrast material and provides a higher diagnostic power for VTOS. SB-MRA is helpful for the diagnosis of TOS of vascular origin.
本文提出了一种新的磁共振血管造影（MRA）协议，用于评估胸廓出口综合征（TOS），该协议允许在单次、同步和双侧（SB-MRA）单对比剂注射的情况下分别评估静脉和动脉，适用于外展和内收采集。
2009 年至 2013 年，我们对 38 例临床疑似 TOS（13 例男性，25 例女性；平均年龄 35.9 岁，标准差=11.13）进行了 MRA 检查。在双侧肘静脉中各放置双外周 20G 静脉导管，并通过两条线与一个连接器连接到一个单功率注射器上。使用具有宽体架的 3T MR 系统。两组四位放射科医生评估了所有图像。A 组评估完整的检查，B 组仅评估晚期采集图像。使用卡方检验评估差异。只有在与临床病史整合后才能确诊 TOS。
17 例（45%）患者被诊断为主要静脉 TOS（VTOS），9 例（24%）为主要动脉 TOS（ATOS），12 例（32%）为不确定或非血管病变。A 组放射科医生识别出更多的 VTOS 比 B 组（p=0.049）。观察者间的一致性非常高。
SB-MRA 是一种安全可靠的 TOS 研究协议。它提供了一个补充的早期采集，允许分别评估静脉和动脉，允许使用单次造影剂注射来研究侧支静脉血流，并为 VTOS 提供更高的诊断能力。SB-MRA 有助于诊断血管源性 TOS。
