三维磁共振血管成像技术及其在肝内门静脉和肝静脉解剖变异中的应用
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摘要
目的:分析比较3D VIBE(Three-dimensional Volumetric InterpolatedBreath-hold Examination)和3D TrueFISP(Three-dimensional True FastImaging Steady-state Precession)两种三维磁共振血管成像序列在肝内门静脉和肝静脉成像方面的优缺点,探讨正常国人肝内门静脉和肝静脉的解剖变异及其与肝脏分段关系,并为肝脏外科切除、肝移植手术提供可靠的肝内血管影像资料。
材料与方法:收集于2004年5月至2005年2月在四川大学华西医院放射科行上腹部MRI检查,并自愿接受增强MR血管成像者100例。其中40例分为A、B两组,两组患者均在增强前行3D TrueFISP序列检查,再分别以相反的顺序进行增强后3D VIBE和3D TrueFISP序列采集,增强序列扫描前均需通过Test bolus检查得到准确的延迟时间。其余60例行增强动态三期3D VIBE扫描。通过方差分析和T检验分别对A、B组三个序列的图像质量进行比较,评定标准包括清晰度、伪影、信号均匀性、静脉强化程度及肝内静脉分支显示级数等定性指标和肝内门静脉、肝静脉的SNR(Signal-Noise Ratio,信噪比)及CNR(Contrast-Noise Ratio,对比度噪声比)等定量指标。此外,还对100例患者的肝内门静脉和肝静脉的解剖变异进行了统计分析。
PURPOSE: (1)To compare the advantages and limitations of twothree-dimensional magnetic resonance angiography sequences--------Volumetric Interpolated Breath-hold Examination (VIBE) and True Fast Imaging Steady-state Precession(TrueFISP) in intrahepatic portal vein and hepatic veins imaging; (2)to analyze the anatomy and variations of the intrahepatic portal vein and hepatic veins in normal Chinese and their impact on segmentation of the liver and surgical planning.MATERIALS AND METHODS: 100 patients underwent the upper abdominal MRA examination in our department during a 9-month period. To sample 40 patients and randomly grouping into A and B group. All the patients in two groups underwent the precontrast TrueFISP and postcontrast VIBE and TrueFISP examinations, but the scan order of the enhanced sequences is different between two groups. Before the enhanced scan ,the delay times of patients in two groups must be obtained through the Test bolus examination. The rest 60 patients only get three phases 3D VIBE scan. To compare the image quality of the three sequences in two groups by One-Way ANOVA and T Test. The qualitative assessment standards include
clarity, artifacts, signal uniformity, the conspicuity of enhanced vein and the observable grade of intrahepatic venous branchs. The quantitative assessment standards include SNR and CNR of intrahepatic portal vein and hepatic veins. Furthermore, the anatomy and variations of the intrahepatic portal vein and hepatic veins are statistical analysed.Results: For aortic ghosting, the scores of c-TrueFISP and c+TrueFISP of two groups are lower than c+VIBE, p<0.05. For the observable grade of intrahepatic venous branchs, the score of c+TrueFISP of two groups is higher than the others, p<0.05. For the conspicuity of hepatic veins, the score of c+TrueFISP is higher than c+VIBE in A group, p<0.05, and for the conspicuity of intrahepatic portal vein, the score of c+TrueFISP is higher than c+VIBE in B group, p<0.05. The compares between two groups indicate the score of the conspicuity of intrahepatic portal vein of c+VIBE in A group is higher than the score in B group, however, the score of the conspicuity of hepatic veins is lower than B group. No significant difference was found among the two groups with regard to other standards. The rates of type I, typell, type III and type IV of intrahepatic portal vein are 82%, 11% , 5%, 2% respectively. The rates of type A, type B and type C of hepatic veins are 71 %, 25%, 4%respectively. There is common trunk in 51% of all the cases. The occurrence rate of inferior right hepatic veins is 29%, dia.5-llmm.CONCLUSION: Both of VIBE and TrueFISP sequences can get the optimal 3D MRA image of the intrahepatic portal vein and hepatic veins and consequently provide details of segmentation and vascular anatomy to facilitate treatment planning.
材料与方法:收集于2004年5月至2005年2月在四川大学华西医院放射科行上腹部MRI检查,并自愿接受增强MR血管成像者100例。其中40例分为A、B两组,两组患者均在增强前行3D TrueFISP序列检查,再分别以相反的顺序进行增强后3D VIBE和3D TrueFISP序列采集,增强序列扫描前均需通过Test bolus检查得到准确的延迟时间。其余60例行增强动态三期3D VIBE扫描。通过方差分析和T检验分别对A、B组三个序列的图像质量进行比较,评定标准包括清晰度、伪影、信号均匀性、静脉强化程度及肝内静脉分支显示级数等定性指标和肝内门静脉、肝静脉的SNR(Signal-Noise Ratio,信噪比)及CNR(Contrast-Noise Ratio,对比度噪声比)等定量指标。此外,还对100例患者的肝内门静脉和肝静脉的解剖变异进行了统计分析。
PURPOSE: (1)To compare the advantages and limitations of twothree-dimensional magnetic resonance angiography sequences--------Volumetric Interpolated Breath-hold Examination (VIBE) and True Fast Imaging Steady-state Precession(TrueFISP) in intrahepatic portal vein and hepatic veins imaging; (2)to analyze the anatomy and variations of the intrahepatic portal vein and hepatic veins in normal Chinese and their impact on segmentation of the liver and surgical planning.MATERIALS AND METHODS: 100 patients underwent the upper abdominal MRA examination in our department during a 9-month period. To sample 40 patients and randomly grouping into A and B group. All the patients in two groups underwent the precontrast TrueFISP and postcontrast VIBE and TrueFISP examinations, but the scan order of the enhanced sequences is different between two groups. Before the enhanced scan ,the delay times of patients in two groups must be obtained through the Test bolus examination. The rest 60 patients only get three phases 3D VIBE scan. To compare the image quality of the three sequences in two groups by One-Way ANOVA and T Test. The qualitative assessment standards include
clarity, artifacts, signal uniformity, the conspicuity of enhanced vein and the observable grade of intrahepatic venous branchs. The quantitative assessment standards include SNR and CNR of intrahepatic portal vein and hepatic veins. Furthermore, the anatomy and variations of the intrahepatic portal vein and hepatic veins are statistical analysed.Results: For aortic ghosting, the scores of c-TrueFISP and c+TrueFISP of two groups are lower than c+VIBE, p<0.05. For the observable grade of intrahepatic venous branchs, the score of c+TrueFISP of two groups is higher than the others, p<0.05. For the conspicuity of hepatic veins, the score of c+TrueFISP is higher than c+VIBE in A group, p<0.05, and for the conspicuity of intrahepatic portal vein, the score of c+TrueFISP is higher than c+VIBE in B group, p<0.05. The compares between two groups indicate the score of the conspicuity of intrahepatic portal vein of c+VIBE in A group is higher than the score in B group, however, the score of the conspicuity of hepatic veins is lower than B group. No significant difference was found among the two groups with regard to other standards. The rates of type I, typell, type III and type IV of intrahepatic portal vein are 82%, 11% , 5%, 2% respectively. The rates of type A, type B and type C of hepatic veins are 71 %, 25%, 4%respectively. There is common trunk in 51% of all the cases. The occurrence rate of inferior right hepatic veins is 29%, dia.5-llmm.CONCLUSION: Both of VIBE and TrueFISP sequences can get the optimal 3D MRA image of the intrahepatic portal vein and hepatic veins and consequently provide details of segmentation and vascular anatomy to facilitate treatment planning.
引文
1. Silverman JM, Podesta L, Villamil F, et al. Portal vein patency in candidates for liver transplantation: MR angiographic analysis. Radiology, 1995, 197(1): 147-52.
2. Hughes LA, Hartnell GG. Finn JP, et al. Time-of-flight MR angiography of the portal venous system: value compared with other imaging procedures. American Journal of Roentgenology, 1996, 166(2):375-8.
3. Nelson RC, Chezmar JL, Sugarbaker PH, et al. Preoperative localization of focal liver lesions to specific liver segments: utility of CT during arterial portography. Radiology, 1990, 176(1):89-94.
4. Soyer P, Roche A, Gad M, et al. Preoperative segmental localization of hepatic metastases: utility of three-dimensional CT during arterial portography. Radiology, 1991, 180(3):653-8.
5. Okumura A, Watanabe Y, Dohke M, et al. Contrast-enhanced three-dimensional MR portography. Radiographics, 1999, 19(4):973-87.
6. Erden A, Erden I, Yagmurlu B, et al. Portal venous system: evaluation with contrast-enhanced 3D MR portography. Clinical Imaging, 2003, 27(2): 101-5.
7. Prince MR. Contrast-enhanced MR angiography: theory and optimization. Magnetic Resonance Imaging Clinics of North America, 1998, 6(2):257-67.
8. Glockner JF. Three-dimensional gadolinium-enhanced MR angiography: applications for abdominal imaging. Radiographics, 2001, 21(2):357-70.
9. Atri M, Bret PM, Fraser-Hill MA. Intrahepatic portal venous variations: prevalence with US. Radiology, 1992, 184(1):157-8.
10. Lafortune M, Madore F, Patriquin H, et al. Segmental anatomy of the liver: a sonographic approach to the Couinaud nomenclature. Radiology, 1991, 181(2): 443-8.
11. Couinaud C. The liver: anatomic and surgical studies. Paris: Masson, 1957. 71-118.
12. Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet, 1981,152 (1): 43—50.
13.赵喜平.磁共振成像系统的原理及其应用.第一版.北京:科学出版社,2000:366.367.
14. Lee VS, Lavelle MT, Rofsky NM, et al. Hepatic MR imaging with a dynamic contrast-enhanced isotropic volumetric interpolated breath-hold examination: feasibility, reproducibility, and technical quality. Radiology, 2000, 215(2):365-72.
15. Foo TK, Ho VB, Marcos HB, et al. MR angiography using steady-state free precession. Magnetic Resonance in Medicine, 2002, 48(4):699-706.
16. Amano Y, Takahama K, Nozaki A, et al. Magnetic resonance portography using contrast-enhanced fat-saturated three-dimensional steady-state free precession imaging. Journal of Magnetic Resonance Imaging, 2004, 19(2):238-44.
17. Earls JP, Rofsky NM, DeCorato DR, et al. Hepatic arterial-phase dynamic gadolinium-enhanced MR imaging: optimization with a test examination and a power injector. Radiology, 1997, 202(1):268-73.
18. Hussain HK, Londy FJ, Francis IR, et al. Hepatic arterial phase MR imaging with automated bolus-detection three-dimensional fast gradient-recalled-echo sequence: comparison with test-bolus method. Radiology, 2003, 226(2):558-66.
19. Krinsky GA, Kaminer E, Lee VS,et al. The effects of apnea on timing examinations for optimization of gadolinium-enhanced MRA of the thoracic aorta and arch vessels. Journal of Computer Assisted Tomography, 1998, 22(5):677-81.
20. Rofsky NM, Lee VS, Laub G, et al. Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology, 1999, 212(3):876-84.
21. Oppelt A, Graumann R, Barfu H, Fischer H, Hartl W, Schajor W. FISP:a new fast MRI sequence. Electromedica (Engl Ed) 1986;54:15-18.
22. Scheffler K, Heid O, Hennig J. Magnetization preparation during the steady state: fat-saturated 3D TrueFISP. Magnetic Resonance in Medicine, 2001, 45(6): 1075-80.
23. Jung B, Krombach GA, Gunther RW, et al. Is postcontrast trueFISP imaging advantageous? Investigative Radiology, 2004, 39(9):517-23.
24. Strunk H, Stuckmann G, Textor J, et al. Limitations and pitfalls of Couinaud's segmentation of the liver in transaxial Imaging. European Radiology, 2003, 13(11):2472-82.
25. Pandharipande PV, Lee VS, Morgan GR, et al. Vascular and extravascular complications of liver transplantation: comprehensive evaluation with three-dimensional contrast-enhanced volumetric MR imaging and MR cholangiopancreatography. American Journal of Roentgenology, 2001, 177(5):1101-7.
26.蒲淼水,钟世镇,周厚伟等.左外叶活体肝移植肝静脉的临床应用解剖.Chinese Journal of Clinical Anatomy,2000,18(4):324—326.
27.刘静,李忠华,王兴海等.右叶部分肝移植肝静脉的临床应用解剖.Chinese Journal of Clinical Anatomy,2004,22(3):234—236.
28. Ward J, Spencer JA, Guthrie JA, et al. Liver transplantation: dynamic contrast-enhanced magnetic resonance imaging of the hepatic vasculature. Clinical Radiology, 1996, 51(3):191-7.
29. Makuuchi M, Hasegawa H, Yamazaki S, et al. Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surgery, Gynecology & Obstetrics, 1987,164(1):68-72.
2. Hughes LA, Hartnell GG. Finn JP, et al. Time-of-flight MR angiography of the portal venous system: value compared with other imaging procedures. American Journal of Roentgenology, 1996, 166(2):375-8.
3. Nelson RC, Chezmar JL, Sugarbaker PH, et al. Preoperative localization of focal liver lesions to specific liver segments: utility of CT during arterial portography. Radiology, 1990, 176(1):89-94.
4. Soyer P, Roche A, Gad M, et al. Preoperative segmental localization of hepatic metastases: utility of three-dimensional CT during arterial portography. Radiology, 1991, 180(3):653-8.
5. Okumura A, Watanabe Y, Dohke M, et al. Contrast-enhanced three-dimensional MR portography. Radiographics, 1999, 19(4):973-87.
6. Erden A, Erden I, Yagmurlu B, et al. Portal venous system: evaluation with contrast-enhanced 3D MR portography. Clinical Imaging, 2003, 27(2): 101-5.
7. Prince MR. Contrast-enhanced MR angiography: theory and optimization. Magnetic Resonance Imaging Clinics of North America, 1998, 6(2):257-67.
8. Glockner JF. Three-dimensional gadolinium-enhanced MR angiography: applications for abdominal imaging. Radiographics, 2001, 21(2):357-70.
9. Atri M, Bret PM, Fraser-Hill MA. Intrahepatic portal venous variations: prevalence with US. Radiology, 1992, 184(1):157-8.
10. Lafortune M, Madore F, Patriquin H, et al. Segmental anatomy of the liver: a sonographic approach to the Couinaud nomenclature. Radiology, 1991, 181(2): 443-8.
11. Couinaud C. The liver: anatomic and surgical studies. Paris: Masson, 1957. 71-118.
12. Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet, 1981,152 (1): 43—50.
13.赵喜平.磁共振成像系统的原理及其应用.第一版.北京:科学出版社,2000:366.367.
14. Lee VS, Lavelle MT, Rofsky NM, et al. Hepatic MR imaging with a dynamic contrast-enhanced isotropic volumetric interpolated breath-hold examination: feasibility, reproducibility, and technical quality. Radiology, 2000, 215(2):365-72.
15. Foo TK, Ho VB, Marcos HB, et al. MR angiography using steady-state free precession. Magnetic Resonance in Medicine, 2002, 48(4):699-706.
16. Amano Y, Takahama K, Nozaki A, et al. Magnetic resonance portography using contrast-enhanced fat-saturated three-dimensional steady-state free precession imaging. Journal of Magnetic Resonance Imaging, 2004, 19(2):238-44.
17. Earls JP, Rofsky NM, DeCorato DR, et al. Hepatic arterial-phase dynamic gadolinium-enhanced MR imaging: optimization with a test examination and a power injector. Radiology, 1997, 202(1):268-73.
18. Hussain HK, Londy FJ, Francis IR, et al. Hepatic arterial phase MR imaging with automated bolus-detection three-dimensional fast gradient-recalled-echo sequence: comparison with test-bolus method. Radiology, 2003, 226(2):558-66.
19. Krinsky GA, Kaminer E, Lee VS,et al. The effects of apnea on timing examinations for optimization of gadolinium-enhanced MRA of the thoracic aorta and arch vessels. Journal of Computer Assisted Tomography, 1998, 22(5):677-81.
20. Rofsky NM, Lee VS, Laub G, et al. Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology, 1999, 212(3):876-84.
21. Oppelt A, Graumann R, Barfu H, Fischer H, Hartl W, Schajor W. FISP:a new fast MRI sequence. Electromedica (Engl Ed) 1986;54:15-18.
22. Scheffler K, Heid O, Hennig J. Magnetization preparation during the steady state: fat-saturated 3D TrueFISP. Magnetic Resonance in Medicine, 2001, 45(6): 1075-80.
23. Jung B, Krombach GA, Gunther RW, et al. Is postcontrast trueFISP imaging advantageous? Investigative Radiology, 2004, 39(9):517-23.
24. Strunk H, Stuckmann G, Textor J, et al. Limitations and pitfalls of Couinaud's segmentation of the liver in transaxial Imaging. European Radiology, 2003, 13(11):2472-82.
25. Pandharipande PV, Lee VS, Morgan GR, et al. Vascular and extravascular complications of liver transplantation: comprehensive evaluation with three-dimensional contrast-enhanced volumetric MR imaging and MR cholangiopancreatography. American Journal of Roentgenology, 2001, 177(5):1101-7.
26.蒲淼水,钟世镇,周厚伟等.左外叶活体肝移植肝静脉的临床应用解剖.Chinese Journal of Clinical Anatomy,2000,18(4):324—326.
27.刘静,李忠华,王兴海等.右叶部分肝移植肝静脉的临床应用解剖.Chinese Journal of Clinical Anatomy,2004,22(3):234—236.
28. Ward J, Spencer JA, Guthrie JA, et al. Liver transplantation: dynamic contrast-enhanced magnetic resonance imaging of the hepatic vasculature. Clinical Radiology, 1996, 51(3):191-7.
29. Makuuchi M, Hasegawa H, Yamazaki S, et al. Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surgery, Gynecology & Obstetrics, 1987,164(1):68-72.