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DOI: 10.1055/s-2002-33398
© Georg Thieme Verlag Stuttgart · New York
Kann die Time-of-Flight-Angiographie in der MRT die präoperative Duplex- und Doppler-Untersuchung der Arteria carotis ersetzen? - Ergebnisse eines prospektiven Vergleichs mit Literaturübersicht
Can TOF MRA replace duplex and Doppler sonography in preoperative assessment of the carotid arteries? A prospective comparison and review of the literaturePublication History
Publication Date:
19 August 2002 (online)
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Zusammenfassung
Studienziel: Überprüfung der Qualität und Anwendbarkeit der Time-of-flight-MR-Angiographie (TOF-MRA) im Vergleich zur Duplex- und Doppler-Sonographie der extrakraniellen Gefäße vor Eingriffen an der Halswirbelsäule. Methode: Patienten vor HWS-Eingriffen erhielten ein MRT der HWS inklusive einer TOF-MRA und eine Duplex- und Doppler-Untersuchung der extrakraniellen Gefäße. Weder der Radiologe noch der beurteilende Neurologe wussten zum Zeitpunkt der Beurteilung von der Untersuchung des jeweiligen anderen. Endpunkt waren inwieweit mit den beiden Verfahren relevante Stenosen festgestellt werden können, vor allem aber inwieweit dadurch der präoperative Ablauf optimiert wurde. Ergebnisse: Bisher konnten 20 Patienten untersucht werden. Nur bei einem Patienten differierte die Beurteilung im Ultraschall (Gefäßverschluss) und im MRA (hochgradige Stenose). Ein Patient tolerierte die MR-Untersuchung nicht lange genug, so dass eine kontrastverstärkte MR-Angiographie durchgeführt wurde. Die MRA-Untersuchung vereinfachte das präoperative Prozedere bei etwas höheren Kosten als die Duplex-/Doppler-Untersuchung. Schlussfolgerung: Die TOF-MRA kann Duplex und Doppler zum Screening der Karotiden ersetzen. Der präoperative Ablaufpfad kann so insbesondere im Fall einer dringenden Operation beschleunigt werden. Ähnlich wie Duplex/Doppler ist die Methode aber nur ausreichend akkurat, wenn der Untersucher über eine große Erfahrung verfügt.
Abstract
Aim: To examine the quality and usefulness of time-of-flight MR-angiography and duplex-doppler sonography, respectively, in assessment of the extracranial arteries before cervical spine operations. Methods: Patients scheduled for operations of the cervical spine had an MRI plus TOF as well as a duplex and Doppler scan. At the time of the examination the radiologist and the neurologist in charge were blinded for the study. Endpoints were not only the accuracy of the procedures but more so which method improved the preoperative process most. Results: Twenty patients were examined so far. Only in one case did the result differ when a complete occlusion diagnosed sonographically was judged as a severe stenosis on MRA. One patient did not tolerate the MRA for the extra 5 minutes necessary, therefore a contrast-enhanced MRA was performed. MRA eased the preoperative process as imaging of the pathology and the carotids were realised in one step. The costs were slightly higher for MRA than for duplex-doppler sonography. Conclusion: TOF-MRA can replace the duplex-doppler examination in the preoperative assessment of the carotids and has the potential to streamline the preoperative time schedule. Similar to duplex and doppler, in order to be accurate enough the method requires a high degree of expertise from the radiologist.
Schlüsselwörter
MR-Angiographie - Gefäßdarstellung - Prozessoptimierung
Key words
MR angiography - diagnostic imaging - process improvement
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