真实稳态快速回波序列结合三维增强磁共振血管成像评价主动脉壁内血肿

摘要

目的 探讨真实稳态快速回波(true FISP)序列结合三维增强磁共振血管成像(3D CE-MRA)评价主动脉壁内血肿(IMH)的临床应用价值.方法 对38例IMH患者行true FISP序列扫描及3D CE-MRA,并进行MRI随访.依据随访结果将IMH患者分为稳定组及进展组,结合初诊及随访MRI对IMH的MR特征、自然史及预后进行分析.结果 38例IMH患者中稳定组25例,进展组13例.38例true FISP序列均可见新月形或环形主动脉壁增厚,且35例主动脉管腔与增厚管壁之间可见光滑的低信号环.Logistic回归分析显示心脑血管病是IMH早期进展的独立预测因素(p=0.012).以主动脉管壁厚度≥11 mm和最大径≥43 mm为阈值,预测IMH早期进展的敏感度和特异度分别为76.92％(10/13)、40.00％(10/25)和69.23％(9/13)、76.00％(19/25).结论 true FISP序列结合3D CE-MRA有助于准确监测IMH的进展,并可为预后判断提供可靠的参考信息.%Objective To observe the clinical application value of true fast imaging steady-state procession (true FISP) sequence combined with three-dimensional contrast enhancement MR angiography (3D CE-MRA) in evaluating the status of aortic intramural hematoma (IMH). Methods Totally 38 patients with IMH underwent MR scan with true FISP sequence and 3D CE-MRA, and the MRI following-up was performed. According to the results of following-up, the patients were divided into stable group and progressive group. MRI manifestations, natural history and prognosis were analyzed with MR images of initial diagnosis and following-up. Results There were 25 patients in stable group and 13 patients in progressive group. Initial MR scan with true FISP sequence revealed incrassate aortic wall in all 38 patients and hypointensity ring between aortic lumen and hematoma in 35 patients. Logistic regression analysis showed that cardio-cerebrovascular disease was an independent predictor for early progress of IMH (P=0. 012). Taking aortic wall thickness ≥11 mm and diameter ≥43 mm as the threshold, the sensitivity and specificity in forecasting early progress of IMH was 76.92% (10/13), 40.00% (10/25), 69.23% (9/13) and 76.00% (19/25). Conclusion True FISP plus sequence combined with 3D CE-MRA is a helpful method to monitor the progress of IMH, which can provide reliable reference information for prognosis.