动脉自旋标记磁共振成像在遗传性出血性远端血管扩张症患者颅内动静脉畸形检测中的应用

Adam Alyafaie, Woody Han, Yi Li, Samuel A Vydro, Maya Vella, Torianna L Truong, Lindsay Park, Daniel Langston, Helen Kim, Miles B Conrad, Steven W Hetts
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引用次数: 0

摘要

背景和目的:遗传性出血性毛细血管扩张症(HHT)是一种常染色体显性遗传病,可导致多种器官和组织的血管畸形,包括脑动静脉畸形。由于脑动静脉畸形有可能导致致残性或致命性颅内出血,因此在 HHT 患者进行磁共振成像/MRA 筛查时,应在病变破裂前对其进行检测。之前的研究表明,与单纯的 MRA 相比,使用对比后 MR 成像序列对 HHT 相关脑动静脉畸形的灵敏度更高。我们现在提供的数据显示,将动脉自旋标记(ASL)灌注序列作为 MR 成像/MRA 检查的一部分,可为该病患者带来更多益处:我们对加州大学旧金山分校遗传性出血性远端血管扩张症卓越中心的 831 名患者进行了回顾性分析。其中,42 名患者拥有完整的 MR 成像/MRA、ASL 灌注扫描和标准 DSA 数据。两名神经放射学专家对成像研究进行了审查,第三名神经放射学专家在必要时提供了裁定:结果:8 名患者在 DSA 上未发现脑动静脉畸形。结果:8 名患者在 DSA 上未发现脑动静脉畸形,其余 34 名患者在 DSA 上发现了 57 个脑动静脉畸形。在 57 个已确定的 AVM 中,51 个(89.5%)在 ASL 上检测到,43 个(75.4%)在传统 MR 成像/MRA 序列上检测到(P = 0.049),8 个病变在 ASL 灌注上检测到,但在传统 MR 成像上未检测到:ASL提高了HHT患者脑动静脉畸形的敏感性。HHT患者的医疗机构应考虑将ASL作为MR成像/MRA综合筛查方案的一部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Arterial Spin-Labeling MR Imaging in the Detection of Intracranial Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia.

Background and purpose: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease that causes vascular malformations in a variety of organs and tissues, including brain AVMs. Because brain AVMs have the potential to cause disabling or fatal intracranial hemorrhage, detection of these lesions before rupture is the goal of screening MR imaging/MRA examinations in patients with HHT. Prior studies have demonstrated superior sensitivity for HHT-related brain AVMs by using postcontrast MR imaging sequences as compared with MRA alone. We now present data regarding the incremental benefit of including arterial spin-labeling (ASL) perfusion sequences as part of MR imaging/MRA screening in patients with this condition.

Materials and methods: We retrospectively analyzed 831 patients at the UCSF Hereditary Hemorrhagic Telangiectasia Center of Excellence. Of these, 42 patients had complete MR imaging/MRA, ASL perfusion scans, and criterion-standard DSA data. Two neuroradiologists reviewed imaging studies and a third provided adjudication when needed.

Results: Eight patients had no brain AVMs detected on DSA. The remaining 34 patients had 57 brain AVMs on DSA. Of the 57 identified AVMs, 51 (89.5%) were detected on ASL and 43 (75.4%) were detected on conventional MR imaging/MRA sequences (P = .049), with 8 lesions detected on ASL perfusion but not on conventional MR imaging.

Conclusions: ASL provides increased sensitivity for brain AVMs in patients with HHT. Inclusion of ASL should be considered as part of comprehensive MR imaging/MRA screening protocols for institutions taking care of patients with HHT.

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