Zusammenfassung
Die kontrastmittelverstärkte 3D-MR-Angiographie erlaubt eine umfassende und diagnostisch akkurate Darstellung der arteriellen Gefäße in Hals, Thorax, Abdomen und Extremitäten. Fortschritte auf dem Gebiet der MR-Geräte-Technologie und die Einführung der kontrastmittelverstärkten MR-angiographischen Techniken haben diese Entwicklung möglich gemacht. Die kontrastmittelverstärkte MR-Angiographie kombiniert die intravenöse Bolus-Gabe eines paramagnetischen Kontrastmittels mit der Akquisition schneller dreidimensionaler Datensätze. Die Möglichkeit der Datenaufnahme in Thorax und Abdomen innerhalb einer Atemanhaltephase, der resultierende hohe Kontrast zwischen Gefäßlumen und umgebendem Weichteilgewebe sowie die inhärente Dreidimensionalität der Bilddaten sorgen für eine diagnostisch aussagekräftige Bildqualität. In vielen Zentren hat die kontrastverstärkte 3D-MR-Angiographie die konventionelle digitale Röntgen-Subtraktionsangiographie bei der Abklärung arterieller Gefäßpathologien bereits weitgehend ersetzt. Diese Arbeit vermittelt einen Überblick über die technischen Grundlagen der kontrastmittelverstärkten 3D-MRA. Darüber hinaus wird auf das Indikationsspektrum hingewiesen und anhand klinischer Fallbeispiele illustriert.
Abstract
Contrast medium-enhanced, 3D MR angiography enables an extensive and diagnostically accurate evaluation of arterial vessels in the neck, thorax, abdomen, and limbs. Advances in the field of MR apparatus technology and the introduction of contrast-medium enhanced MR angiographic techniques have made this development possible. Contrast medium-enhanced MR angiography combines the intravenous bolus administration of a paramagnetic contrast medium with the rapid acquisition of 3D datasets. The possibilities for obtaining data in the throax and abdomen within one breath-hold, the resulting high contrast between vessel lumen and surrounding soft tissue as well as the inherent 3D nature of the images allow for diagnostically relevant image quality. In many centers contrast-enhanced 3D MR angiography has widely replaced the conventional digital subtraction roentgenography for the clarification of pathologies in arterial vessels. This review presents a survey of the technical background of contrast medium e¿nhanced 3D MRA. In addition, the spectrum of indications is given and discussed on the basis of clinical examples.
Schlüsselwörter
MR-Angiographie - dreidimensionale Bildgebung - Kontrastmittel - Gefäßuntersuchung - Technik - A. carotis - Pulmonalarterien - Aorta - Nierenarterien - periphere Arterien - Gefäßkrankheiten
Key words
MR angiography - three-dimensional imaging - contrast media - vascular study - technique - carotid artery - pulmonary arteries - aorta - renal arteries - peripheral arteris - vascular disease
Literatur
-
1
Prince M R, Yucel E K, Kaufman J A, Harrison D C, Geller S C.
Dynamic gadoliniumenhanced three-dimensional abdominal MR arteriography.
J Magn Reson Imaging.
1993;
3
877-881
-
2
Edelman R R, Chien D, Kim D.
Fast selective black blood MR imaging.
Radiology.
1991;
181
655-660
-
3
Atkinson D J, Edelman R R.
Cineangiography of the heart in a single breath hold with a segmented turboFLASH sequence.
Radiology.
1991;
178
357-360
-
4
Pelc N J, Herfkens R J, Shimakawa A, Enzmann D R.
Phase contrast cine magnetic resonance imaging.
Magn Reson Q.
1991;
7
229-254
-
5
Walker M F, Souza S P, Dumoulin C L.
Quantitative flow measurement in phase contrast MR angiography.
J Comput Assist Tomogr.
1988;
12
304-313
-
6
Debatin J F, Zahner B, Meyenberger C, Romanowski B, Schopke W, Marincek B, Fuchs W A.
Azygos blood flow: phase contrast quantitation in volunteers and patients with portal hypertension pre- and postintrahepatic shunt placement.
Hepatology.
1996;
24
1109-1115
-
7
Steiner P, McKinnon G C, Romanowski B, Goehde S C, Hany T, Debatin J F.
Contrast-enhanced, ultrafast 3D pulmonary MR angiography in a single breath-hold: initial assessment of imaging performance.
J Magn Reson Imaging.
1997;
7
177-182
-
8
Korosec F R, Frayne R, Grist T M, Mistretta C A.
Time-resolved contrast-enhanced 3D MR angiography.
Magn Reson Med.
1996;
36
345-351
-
9
Ruehm S G, Nanz D, Baumann A, Schmid M, Debatin J F.
3D contrast-enhanced MR angiography of the run-off vessels: Value of image subtraction.
J Magn Reson Imaging.
2001;
13
402-411
-
10
Ruehm S G, Hany T F, Pfammatter T, Schneider E, Ladd M, Debatin J F.
Pelvic and lower extremity arterial imaging: diagnostic performance of three-dimensional contrast-enhanced MR angiography.
Am J Roentgenol.
2000;
174
1127-1135
-
11
Ruehm S G, Goyen M, Quick H H, Schleputz M, Schleputz H, Bosk S, Barkhausen J, Ladd M E, Debatin J F.
Ganzkörper-MRA auf einer rollenden Tischplattform (AngioSURF).
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verahr.
2000;
172
670-674
-
12
Prince M R, Narasimham D L, Stanley J C, Chenevert T L, Williams D M, Marx M V, Cho K J.
Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches.
Radiology.
1995;
197
785-792
-
13
Prince M R, Arnoldus C, Frisoli J K.
Nephrotoxicity of high-dose gadolinium compared with iodinated contrast.
J Magn Reson Imaging.
1996;
6
162-166
-
14
Haustein J, Niendorf H P, Krestin G, Louton T, Schuhmann-Giampieri G, Clauss W, Junge W.
Renal tolerance of gadolinium-DTPA/dimeglumine in patients with chronic renal failure.
Invest Radiol.
1992;
27
153-156
-
15
Hany T F, McKinnon G C, Leung D A, Pfammatter T, Debatin J F.
Optimization of contrast timing for breath-hold three-dimensional MR angiography.
J Magn Reson Imaging.
1997;
7
551-556
-
16
Ho V B, Choyke P L, Foo T K, Hood M N, Miller D L, Czum J M, Aisen A M.
Automated bolus chase peripheral MR angiography: initial practical experiences and future directions of this work-in-progress.
J Magn Reson Imaging.
1999;
10
376-388
-
17
Floemer F, Glombitza G, Knopp M V, Schoenberg S O, Brockmeier K, Meinzer H P.
Virtuelle Realität in der radiologischen Diagnostik: Anwendung der virtuellen Realität für MRA-Daten komplexer Gefäßstrukturen.
Radiologe.
2000;
40
246-255
-
18
Hany T F, Schmidt M, Davis C P, Gohde S C, Debatin J F.
Diagnostic impact of four postprocessing techniques in evaluating contrast-enhanced three-dimensional MR angiography.
Am J Roentgenol.
1998;
170
907-912
-
19
Cloft H J, Murphy K J, Prince M R, Brunberg J A.
3D gadolinium-enhanced MR angiography of the carotid arteries.
Magn Reson Imaging.
1996;
14
593-600
-
20
Parker D L, Yuan C, Blatter D D.
MR angiography by multiple thin slab 3D acquisition.
Magn Reson Med.
1991;
17
434-451
-
21
Link J, Muller-Hulsbeck S, Wesner F, Hopfner M, Schwarzenberg H, Heller M.
3-D-CT-Angiographie und Duplexsonographie im Vergleich zur Arteriographie bei Karotisstenosen.
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr.
1997;
166
30-35
-
22
Rasanen H T, Manninen H I, Vanninen R L, Vainio P, Berg M, Saari T.
Mild carotid artery atherosclerosis: assessment by 3-dimensional time-of-flight magnetic resonance angiography, with reference to intravascular ultrasound imaging and contrast angiography.
Stroke.
1999;
30
827-833
-
23
Value of the ventilation/perfusion scan in acute pulmonary e mbolism.
Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators.
Jama.
1990;
263
2753-2759
-
24
Meaney J F, Weg J G, Chenevert T L, Stafford-Johnson D, Hamilton B H, Prince M R.
Diagnosis of pulmonary embolism with magnetic resonance angiography.
N Engl J Med.
1997;
336
1422-1427
-
25
Goyen M, Laub G, Ladd M E, Debatin J F, Barkhausen J, Truemmler K H, Bosk S, Ruehm S G.
Dynamic 3D MR angiography of the pulmonary arteries in under four seconds.
J Magn Reson Imaging.
2001;
13
372-377
-
26
Goyen M, Ruehm S G, Jagenburg A, Barkhausen J, Kroger K, Debatin J F.
Pulmonary arteriovenous malformation: Characterization with time-resolved ultrafast 3D MR angiography.
J Magn Reson Imaging.
2001;
13
458-460
-
27
Schoenberg S O, Bock M, Floemer F, Grau A, Williams D M, Laub G, Knopp M V.
High-resolution pulmonary arterio- and venography using multiple-bolus multiphase 3D-Gd-MRA.
J Magn Reson Imaging.
1999;
10
339-346
-
28
Hany T F, Debatin J F, Leung D A, Pfammatter T.
Evaluation of the aortoiliac and renal arteries: comparison of breath-hold, contrast-enhanced, three-dimensional MR angiography with conventional catheter angiography.
Radiology.
1997;
204
357-362
-
29
Krinsky G A, Rofsky N M, DeCorato D R, Weinreb J C, Earls J P, Flyer M A, Galloway A C, Colvin S B.
Thoracic aorta: comparison of gadolinium-enhanced three-dimensional MR angiography with conventional MR imaging.
Radiology.
1997;
202
183-193
-
30
Prince M R, Narasimham D L, Jacoby W T, Williams D M, Cho K J, Marx M V, Deeb G M.
Three-dimensional gadolinium-enhanced MR angiography of the thoracic aorta.
Am J Roentgenol.
1996;
166
1387-1397
-
31
Prince M R, Narasimham D L, Stanley J C, Wakefield T W, Messina L M, Zelenock G B, Jacoby W T, Marx M V, Williams D M, Cho K J.
Gadolinium-enhanced magnetic resonance angiography of abdominal aortic aneurysms.
J Vasc Surg.
1995;
21
656-669
-
32
Ruehm S G, Weishaupt D, Debatin J F.
Contrast-enhanced MR angiography in patients with aortic occlusion (Leriche syndrome).
J Magn Reson Imaging.
2000;
11
401-410
-
33
Snidow J J, Johnson M S, Harris V J, Margosian P M, Aisen A M, Lalka S G, Cikrit D F, Trerotola S O.
Three-dimensional gadolinium-enhanced MR angiography for aortoiliac inflow assessment plus renal artery screening in a single breath hold.
Radiology.
1996;
198
725-732
-
34
Holland G A, Dougherty L, Carpenter J P, Golden M A, Gilfeather M, Slossman F, Schnall M D, Axel L.
Breath-hold ultrafast three-dimensional gadolinium-enhanced MR angiography of the aorta and the renal and other visceral abdominal arteries [published erratum appears in Am J Roentgenol 1996 Aug; 167 (2): 541].
Am J Roentgenol.
1996;
166
971-981
-
35
Leung D A, Hoffmann U, Pfammatter T, Hany T F, Rainoni L, Hilfiker P, Schneider E, Zimmermann-Paul G G, Debatin J F.
Magnetic resonance angiography versus duplex sonography for diagnosing renovascular disease.
Hypertension.
1999;
33
726-731
-
36
Schoenberg S O, Knopp M V, Bock M, Kallinowski F, Just A, Essig M, Hawighorst H, Schad L, van Kaick G.
Renal artery stenosis: grading of hemodynamic changes with cine phase-contrast MR blood flow measurements.
Radiology.
1997;
203
45-53
-
37
Prince M R, Schoenberg S O, Ward J S, Londy F J, Wakefield T W, Stanley J C.
Hemodynamically significant atherosclerotic renal artery stenosis: MR angiographic features.
Radiology.
1997;
205
128-136
-
38
Ho K Y, Leiner T, de Haan M W, Kessels A G, Kitslaar P J, van Engelshoven J M.
Peripheral vascular tree stenoses: evaluation with moving-bed infusion-tracking MR angiography [see comments].
Radiology.
1998;
206
683-692
-
39
Meaney J F, Ridgway J P, Chakraverty S, Robertson I, Kessel D, Radjenovic A, Kouwenhoven M, Kassner A, Smith M A.
Stepping-table gadolinium-enhanced digital subtraction MR angiography of the aorta and lower extremity arteries: preliminary experience.
Radiology.
1999;
211
59-67
-
40
Goyen M, Ruehm S G, Barkhausen J, Kroger K, Ladd M E, Truemmler K H, Bosk S, Requardt M, Reykowski A, Debatin J F.
Improved multi-station peripheral MR angiography with a dedicated vascular coil.
J Magn Reson Imaging.
2001;
13
475-480
-
41
Lenhart M, Herold T, Volk M, Seitz J, Manke C, Zorger N, Dorenbeck U, Requardt M, Nitz W R, Kasprzak P, Feuerbach S, Link J.
Kontrastmittelverstärkte MR-Angiographie der Becken- und Beinarterien mit Schrittverschiebetechnik unter Einsatz eines dedizierten Spulensystems. Erste klinische Erfahrungen.
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr.
2000;
172
992-999
-
42
Ruehm S G, Goyen M, Barkhausen J, Kroger K, Bosk S, Ladd M E, Debatin J F.
Rapid magnetic resonance angiography for detection of atherosclerosis.
Lancet.
2001;
357
1086-1091
-
43
Grist T M, Korosec F R, Peters D C, Witte S, Walovitch R C, Dolan R P, Bridson W E, Yucel E K, Mistretta C A.
Steady-state and dynamic MR angiography with MS-325: initial experience in humans.
Radiology.
1998;
207
539-544
-
44
Lauffer R B, Parmelee D J, Dunham S U, Ouellet H S, Dolan R P, Witte S, McMurry T J, Walovitch R C.
MS-325: albumin-targeted contrast agent for MR angiography.
Radiology.
1998;
207
529-538
-
45
Adam G, Neuerburg J, Spuntrup E, Muhler A, Scherer K, Gunther R W.
Dynamic contrast-enhanced MR imaging of the upper abdomen: enhancement properties of gadobutrol, gadolinium-DTPA-polylysine, and gadolinium-DTPA-cascade-polymer.
Magn Reson Med.
1994;
32
622-628
-
46
Clarke E, Martell A.
Stabilities of trivalent metal ion complexes of the tetraacetate derivatives of 12-, 13- and 14-membered tetraazamacrocycles.
Inorg Chem Acta.
1991;
190
37-46
-
47
Knopp M V, von Tengg-Kobligk H, Floemer F, Schoenberg S O.
Contrast agents for MRA: future directions.
J Magn Reson Imaging.
1999;
10
314-316
Priv.-Doz. Dr. S. G. Ruehm
Zentralinstitut für Röntgendiagnostik Universitätsklinikum Essen
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