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DOI: 10.1055/s-2004-814666
Entzündliches Aortenbogensyndrom: Stenosediagnostik mittels kontrastmittelverstärkter 3D-MR-Angiographie im Vergleich mit der DSA
Inflammatory Aortic Arch Syndrome: Contrast-Enhanced, Three-Dimensional MR Angiography in Stenotic LesionsPublication History
Publication Date:
08 January 2004 (online)
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Zusammenfassung
Ziel: Bestimmung der Aussagekraft der kontrastmittelverstärkten 3D-Magnetresonanzangiographie bei der Bewertung stenosierender und okkludierender Gefäßveränderungen im Rahmen des entzündlichen Aortenbogensyndroms. Material und Methoden: Bei 14 Patienten mit entzündlichem Aortenbogensyndrom (Arteriitis temporalis: n = 8, Takayasu-Arteriitis: n = 4, Morbus Bechterew: n = 1, Sarkoidose: n = 1) erfolgte eine MRA des Aortenbogens und der supraaortalen Äste (n = 15, darunter zwei Doppeluntersuchungen) sowie der Aorta abdominalis (n = 2). Zur Anwendung kam eine kontrastmittelverstärkte 3D-FLASH-Sequenz (TR/TE 4,6/1,8 ms, Flipwinkel 30°) an einem 1,5 Tesla-System. Die Befunde der MRA wurden mit der DSA als Referenzmethode verglichen. Ergebnisse: Es erfolgte die Untersuchung von insgesamt 467 Gefäßterritorien, in denen mittels DSA 50 Stenosen und 35 Verschlüsse nachgewiesen wurden. Sämtliche Läsionen wurden in der MRA detektiert, der Stenosegrad wurde bei 23 Segmenten überschätzt. Sensitivität und Spezifität der MRA betrugen 100 bzw. 94,3 %, positiver und negativer Vorhersagewert 73,6 % bzw. 100 % bei einer Genauigkeit von 95,1 %. Schlussfolgerung: Die kontrastmittelverstärkte 3D-MRA stellt trotz einer Tendenz zur Überschätzung des Stenosegrades ein aussagekräftiges, nicht-invasives Verfahren für die Diagnostik des entzündlichen Aortenbogensyndroms dar.
Abstract
Purpose: To determine the value of contrast-enhanced, three-dimensional MR angiography for the evaluation of stenotic and occlusive vascular lesions in inflammatory aortic arch syndrome. Materials and Methods: 14 patients with inflammatory aortic arch syndrome (giant cell arteritis: n = 8, Takayasu arteritis: n = 4, ankylosing spondylitis: n = 1 sarcoidosis: n = 1) underwent MR angiography of the aortic arch and the supra-aortic vessels (n = 15, 2 patients were examined twice) and of the abdominal aorta (n = 2). MRA was performed using a 3D-FLASH sequence (TR/TE 4.6/1.8 ms, flip angle 30 ³) on a 1.5T system. MRA imaging was compared with the findings of DSA, which served as gold standard. Results: In a total of 467 examined vascular territories, DSA revealed 50 stenoses and 35 occlusions. All lesions were detected by MRA. In 23 segments, the degree of stenosis was overestimated by MRA. Sensitivity and specificity of MRA were 100 % and 94.3 %, positive and negative predictive values were 73.6 and 100 %, and the accuracy was 95.1 %. Conclusions: Despite a tendency to overestimate stenoses, contrast-enhanced three-dimensional MR angiography is a valid, non-invasive technique in the assessment of inflammatory aortic arch syndrome.
Key words
Inflammatory aortic arch syndrome - vasculitis - stenosis - occlusion - MRA - DSA
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Dr. med. Marcus Both
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