Carriero A, Palumbo L, Tonni A G, D'Angelo C, Magarelli N, Bonomo L
Istituto di Scienze Radiologiche, Università di Chieti, Siemens, Pescara.
Radiol Med. 1995 Dec;90(6):719-25.
The authors report on their clinical experience with Magnetic Resonance angiography (MRA) pitfalls. January, 1989, to February, 1995, six hundred MRA examinations were performed in different vascular districts, with a 1.5-T superconductive magnet, the time-of-flight (TOF) technique and 2D and 3D acquisitions. Intracranial arteries, epiaortic vessels and renal arteries were studied with FISP 3D sequences; intracranial veins, thoracic vessels, vena cava and pelvic vessels were studied with FISP 2D sequences. Pitfalls were observed in 56 of 600 MRA exams (9.3%). Of 56 pitfalls, 26 (46.4%) were in epiaortic vessels, 15 (26.7%) in intracranial vessels, 6 (10.7%) in renal arteries, 6 (10.7%) in thoracic vessels, 1 (1.7%) in the inferior vena cava and 2 (3.5%) in iliac vessels. Stenoses were overestimated in 21 patients and underestimated in three; 16 patients were misdiagnosed and 16 were false positives. As for cerebral vascular lesions, 5 aneurysms and 7 transverse sinus thromboses were false positives, while 3 lesions were misdiagnosed as venous angiomas. As for 26 MRA exams of thoracic vessels, stenoses were overestimated in 16 patients and underestimated in 10 patients with subclavian steal syndrome, where the left vertebral artery was misinterpreted as occluded. In 6 MRA exams of thoracic vessels, 1 patient was misdiagnosed as having an aneurysm and 5 patients were misdiagnosed as having lung cancer infiltrating aorta and superior vena cava. As for renal vessels, 2 normal renal arteries were misdiagnosed as false positives and 4 stenoses were overestimated. In the inferior vena cava, a partial agenesis was misinterpreted as thrombosis. In 2 MRA exams of iliac vessels, a stenosis and a thrombosis were misinterpreted as false positives. Our experience suggests that MRA pitfalls are caused by the incorrect use of the various techniques. The pitfalls we observed can be classified as caused by three types of artifacts: saturation, turbulence and paramagnetic substance artifacts.
作者报告了他们在磁共振血管造影（MRA）陷阱方面的临床经验。1989年1月至1995年2月，使用1.5-T超导磁体、飞行时间（TOF）技术以及二维和三维采集方式，在不同血管区域进行了600次MRA检查。采用快速成像稳态进动（FISP）三维序列研究颅内动脉、主动脉弓血管和肾动脉；采用FISP二维序列研究颅内静脉、胸段血管、腔静脉和盆腔血管。在600次MRA检查中有56次（9.3%）观察到陷阱。在这56个陷阱中，26个（46.4%）出现在主动脉弓血管，15个（26.7%）出现在颅内血管，6个（10.7%）出现在肾动脉，6个（10.7%）出现在胸段血管，1个（1.7%）出现在下腔静脉，2个（3.5%）出现在髂血管。21例患者的狭窄被高估，3例被低估；16例患者被误诊，16例为假阳性。对于脑血管病变，5个动脉瘤和7个横窦血栓形成被误诊为假阳性，而3个病变被误诊为静脉血管瘤。对于26例胸段血管的MRA检查，16例患者的狭窄被高估，10例锁骨下动脉盗血综合征患者的狭窄被低估，其中左椎动脉被误判为闭塞。在6例胸段血管的MRA检查中，1例患者被误诊为患有动脉瘤，5例患者被误诊为患有肺癌侵犯主动脉和上腔静脉。对于肾血管，2条正常肾动脉被误诊为假阳性，4处狭窄被高估。在下腔静脉，部分发育不全被误判为血栓形成。在2例髂血管的MRA检查中，1处狭窄和1处血栓形成被误判为假阳性。我们的经验表明，MRA陷阱是由各种技术使用不当引起的。我们观察到的陷阱可分为由三种伪影引起：饱和伪影、湍流伪影和顺磁性物质伪影。
