Choyke P L, Walther M M, Wagner J R, Rayford W, Lyne J C, Linehan W M
Department of Diagnostic Radiology, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, USA.
Radiology. 1997 Dec;205(3):767-71. doi: 10.1148/radiology.205.3.9393533.
To evaluate the use of dual-phase three-dimensional magnetic resonance (MR) angiography in the preoperative staging of renal cancer.
MR angiography was performed in 18 patients before performance of partial (n = 7), radical (n = 10), or laparoscopic (n = 1) nephrectomy to treat renal cancer. Dynamic, three-dimensional MR angiograms were obtained with gadoteridol enhancement, breath holding, and a three-dimensional spoiled gradient-echo sequence. Images were obtained at 15-second intervals to achieve opacification of arteries and veins. Source, maximum intensity projection, and multiplanar reconstruction images were evaluated. Imaging results were compared with surgical findings.
Renal arterial phase MR angiograms depicted 30 of 31 (97%) surgically confirmed renal arteries, with one false-positive result (an artery that arose from an early-branching single main renal artery, interpreted as a separate accessory artery). Renal venous phase MR angiograms depicted all seven instances of renal vein involvement, including extension to the inferior vena cava in two patients. Collateral vessels around the tumor, including prominent gonadal veins in three patients, were demonstrated. Additional findings included adenopathy and adrenal and pulmonary metastases.
Dual-phase MR angiography of the kidney may be a useful technique in depicting renal vessels before nephrectomy.
评估双期三维磁共振（MR）血管造影在肾癌术前分期中的应用。
对18例拟行部分肾切除术（n = 7）、根治性肾切除术（n = 10）或腹腔镜肾切除术（n = 1）治疗肾癌的患者进行MR血管造影。采用钆特醇增强、屏气及三维扰相梯度回波序列获取动态三维MR血管造影图像。每隔15秒采集图像以实现动静脉显影。对原始图像、最大密度投影图像及多平面重建图像进行评估。将影像学结果与手术所见进行比较。
肾动脉期MR血管造影显示31条手术证实的肾动脉中的30条（97%），有1例假阳性结果（一条起源于早期分支的单一主肾动脉的动脉被误判为单独的副肾动脉）。肾静脉期MR血管造影显示了所有7例肾静脉受累情况，包括2例累及下腔静脉。显示了肿瘤周围的侧支血管，包括3例患者中明显增粗的性腺静脉。其他发现包括淋巴结病以及肾上腺和肺转移。
肾脏双期MR血管造影可能是肾切除术前显示肾血管的一种有用技术。
