Leclerc X, Martinat P, Godefroy O, Lucas C, Giboreau F, Ares G S, Leys D, Pruvo J P
Department of Radiology, University Hospital of Lille, France.
AJNR Am J Neuroradiol. 1998 Sep;19(8):1405-13.
The purpose of this study was to assess the effectiveness of contrast-enhanced fast three-dimensional (3D) MR angiography in depicting both the carotid and vertebral arteries in their cervical portions and to compare MR angiography with conventional angiography for the evaluation of arteriosclerotic disease.
Twenty-seven patients with ischemic cerebral events in the anterior (n = 18) and posterior (n = 9) circulation underwent contrast-enhanced 3D MR angiography in the coronal plane. MR angiograms were examined in a blinded fashion by two observers independently. Stenosis was classified according to the appearance of the residual lumen (no stenosis, mild stenosis, moderate stenosis, severe stenosis, occlusion). Conventional angiography was used as the standard of reference.
Proximal great vessels and carotid siphons were not assessable on MR angiograms in 35% of cases owing to limited coverage. All cervical and petrous segments of the internal carotid arteries (ICAs) and 93% of the extracranial vertebral arteries were assessable. Flow-related artifacts were observed in seven cases of severe stenosis, including three with signal void at the site of narrowing and four with signal loss in the distal ICA. Interobserver agreement was good and significant. Overall agreement between 3D MR angiography and conventional angiography was good for the anterior and posterior circulations despite a tendency toward overestimation of stenoses on MR angiograms. Clinically relevant stenoses and occlusions were correctly identified on 3D MR angiograms, providing good sensitivity and specificity.
Contrast-enhanced 3D MR angiography is a promising tool for assessing arteriosclerotic lesions of supraaortic vessels. Further studies with larger groups are required to determine its value for patient care.
本研究旨在评估对比增强快速三维（3D）磁共振血管造影术在显示颈段颈内动脉和椎动脉方面的有效性，并将磁共振血管造影术与传统血管造影术用于评估动脉硬化疾病时进行比较。
27例在前循环（n = 18）和后循环（n = 9）发生缺血性脑事件的患者接受了冠状面对比增强3D磁共振血管造影检查。两名观察者以盲法独立检查磁共振血管造影图像。根据残余管腔的表现（无狭窄、轻度狭窄、中度狭窄、重度狭窄、闭塞）对狭窄进行分类。以传统血管造影术作为参考标准。
由于覆盖范围有限，35%的病例在磁共振血管造影图像上无法评估近端大血管和颈动脉虹吸部。颈内动脉（ICA）的所有颈段和岩骨段以及93%的颅外椎动脉均可评估。在7例重度狭窄病例中观察到血流相关伪影，其中3例在狭窄部位出现信号缺失，4例在ICA远端出现信号丢失。观察者间一致性良好且具有显著性。尽管磁共振血管造影图像上有高估狭窄程度的倾向，但3D磁共振血管造影术与传统血管造影术在前循环和后循环方面的总体一致性良好。3D磁共振血管造影图像上正确识别了临床相关的狭窄和闭塞，具有良好的敏感性和特异性。
对比增强3D磁共振血管造影术是评估主动脉弓上血管动脉硬化病变的一种有前景的工具。需要进行更大样本量的进一步研究以确定其对患者治疗的价值。
