European Radiology:如何实现低剂量MRA的动静脉畸形显影?

2022-07-24 shaosai MedSci原创

现阶段,使用钆剂(GBCA)的动态增强磁共振血管成像已被认为是替代DSA的一种无创成像方法。

常规数字减影血管造影(DSA)由于其高空间和时间分辨率,是诊断颅内和颅外血管病变的标准,评估包括动静脉畸形(AVM)和动静脉瘘(AVF)在内的动静脉分流(AVS)重要的成像方式之一。然而,由于DSA有神经系统并发症的风险,并且在手术过程中需要暴露于电离辐射,因此并不适合用于随访观察或筛查。

现阶段使用钆剂(GBCA)的动态增强磁共振血管成像已被认为是替代DSA的一种无创成像方法。最近的研究表明,采用迭代重建的TWIST(IT-TWIST)改善了微血管的可视化程度。由于对GBCA在人体内蓄积的安全担忧,使用低剂量GBCA TWIST-MRA与迭代重建(以下简称IT-TWIST-MRA)可实现对AVS的准确识别。据我们所知,尚未有研究使用IT-TWIST-MRA评估全脑和颈部AVS的效用,以及IT-TWIST-MRA与其他成像方式(如DSA)之间的一致性。

近日,发表在European Radiology杂志的一项研究评估了IT-TWIST-MRA与低剂量GBCA作为头颈部的4D MR-DSA的技术可行性,并比较了IT-TWIST-MRA在评估AVS时的诊断性能,为临床选择筛查及随访手段提供了新的选择及参考。

项研究在2016年9月至2019年10月期间29名已知AVS患者在3-T MRI扫描仪上进行了TWIST-MRA检查,使用低剂量注射钆造影剂(GBCA),进行了傅里叶和迭代重建。对图像质量进行了视觉评估,以划定(a)正常的脑动脉和静脉以及(b)AVS的供血、分流和引流血管。进行兴趣区评估,以评价脑血管信号强度的栓塞清晰度和基线信号的波动,比较了TWIST-MRA和IT-TWIST-MRA对AVS的检测。采用配对样本Wilcoxon检验来检验TWIST-MRA和IT-TWIST-MRA之间的差异。 

使用IT-TWIST-MRA重建的图像对正常血管和AVS血管结构的可视化评分明显优于使用TWIST-MRA的图像。除上矢状窦(SSS)外,IT-TWIST-MRA的峰值信号和时间强度曲线的增强斜率都明显高于TWIST-MRA。除SSS外,IT-TWIST-MRA的基线强度波动明显低于TWIST。 


 用于定量分析兴趣区域安置.ICA,颈内动脉;M1,大脑中动脉(MCA)的M1部分;M2,MCA的M2部分;SSS,上矢状窦;StS,直窦;SCV,大脑浅静脉

本研究表明,迭代重建产生的4D MR-DSA图像可满足临床实践中的对图像的要求,即使使用低剂量的GBCA也能清晰显示AVS,因此IT-TWIST-MRA可成为传统DSA和MRI评估和监测AVS的一个有用的辅助成像选择。

原文出处:

Akihiko Sakata,Ryo Sakamoto,Yasutaka Fushimi,et al.Low-dose contrast-enhanced time-resolved angiography with stochastic trajectories with iterative reconstruction (IT-TWIST-MRA) in brain arteriovenous shunt.DOI:10.1007/s00330-022-08678-7

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    2023-02-19 fusion
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    2023-06-26 feather89
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    2022-07-26 wushaoling
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    2022-07-26 FukaiBao

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