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DOI: 10.1055/s-2000-9214
© Georg Thieme Verlag Stuttgart · New York
Kontrastmittelverstärkte 3D-MR-Angiographie vor endoluminaler Therapie von Aneurysmen der Aorta abdominalis und der Becken-Bein-Strombahn
Publication History
Publication Date:
31 December 2000 (online)
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Zusammenfassung.
Zielsetzung: Zur exakten Vermessung aortaler und peripher-arterieller Aneurysmen vor Versorgung mit Stent-Grafts ist die DSA als projektionsabhängiges Verfahren nur bedingt geeignet. Untersucht wurde, inwieweit die kontrastmittelverstärkte 3D-MR-Angiographie (3D-KM-MRA) als Zusatzuntersuchung Nachteile der DSA ausgleichen kann. Patienten und Methoden: 21 Patienten mit 35 Aneurysmen (14 aortal, 9 iliakal, 12 femoropopliteal) erhielten vor der endoluminalen Behandlung eine DSA mit Messkatheter (7) oder Lineal (14) und eine 3D-KM-MRA (TR/TE 7,8/2,1 ms, Flip-Winkel 40 °, Matrix 512 × 224, FOV 500 mm, eff. Schichtd. 1,8 mm). Die Aneurysmen wurden nach Verfahren getrennt befundet und vermessen. Zur Abschätzung des DSA-Messfehlers wurde die 3D-KM-MRA als projektionsunabhängiges Referenzverfahren gewertet. Ergebnisse: Innendurchmesser und Länge von Aneurysmen wurden in DSA mit Lineal regelmäßig unterschätzt. Die Abweichung reichte von 15 % (± 6 %) an der Bauchaorta bis 21 % ( ± 10 %) iliakal. Längsmaße aus Messkatheter-DSA stimmten mit der MRA überein. In MRA-Einzelschichten konnten bei 2/35 Aneurysmen Thromben nachgewiesen werden, die die tatsächliche Länge des Aneurysmas in den DSA maskierten. 2/5 akzessorischen Nierenarterien wurden mit 3D-KM-MRA nicht erkannt. Schlussfolgerungen: Die 3D-KM-MRA ergänzt die DSA bei der Diagnostik aortaler und peripher-arterieller Aneurysmen. Sie ermöglicht, thrombosierte Anteile zu erfassen und Gefäße frei von Projektionseffekten zu vermessen.
Gadolinium-enhanced three-dimensional MR angiography before endovascular treatment of aneurysms in the abdominal aorta, iliac and peripheral vessels.
Purpose: The value of DSA for the measurement of aortic and peripheral arterial aneurysm dimensions before endovascular treatment is limited by projection effects. It was evaluated if additional gadolinium-enhanced three-dimensional MR angiography (3D-CEMRA) could compensate for the disadvantages of DSA. Materials and Methods: 21 patients with 35 aneurysms in the abdominal aorta (14), iliac (9) and femoropopliteal vessels (12) were assessed with DSA (7 with calibrated catheter, 14 with yardstick) and 3D-CEMRA (TR/TE 7.8/2.1 ms, flip-angle 40 °, Matrix 512 × 224, FOV 500 mm, eff. slice 1.8 mm). We measured and compared aneurysm dimensions on both modalities. 3D-CEMRA was regarded as the reference method to evaluate the dimension of DSA-projection effects. Results: Diameter and length of aneurysms were underestimated on DSA with the yardstick as reference. The deviation ranged from 15 % (± 5 %) in the aorta to 21 % (± 10 %) in the iliac vessels. Only with calibrated catheters as reference (7/21 DSA), were the distances on DSA correlated well with MRA. In 2/35 aneurysms 3D-CEMRA detected thrombosis with a difference between length of inner lumen dilatation on DSA and whole aneurysm length. 2/5 accessory renal arteries found on DSA were not detected on 3D-CEMRA. Conclusions: 3D-CEMRA is a valuable adjunct to DSA for pre-interventional diagnostics of aortic and peripheral arterial aneurysms. It provides exact evaluation of aneurysm dimensions and information about partial thrombosis.
Schlüsselwörter:
Aneurysmen - Bauchaorta - Periphere Gefäße - MRA - DSA
Key words:
Aneurysm - Abdominal aorta - Peripheral arteries - MRA - DSA
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Dr. med. Jürgen Biederer
Klinik für Diagnostische Radiologie an der Christian-Albrechts-Universität zu Kiel
Arnold-Heller-Straße 9
24105 Kiel
Phone: + 49-431-597-3153
Fax: + 49-431-597-3151
Email: juergen.biederer@rad.uni-kiel.de