Primerjava magnetno resonančne angiografije in računalniško tomografske angiografije za prikaz disekcij vratnih arterij : diplomsko delo

Mašič, Nejc (avtor), Stropnik, Martin (avtor), Podobnik, Janez (mentor), Romarić, Katja (komentor)

Uvod: Izraz disekcija predstavlja raztrganino v steni arterije, ki omogoča prehod krvi preko notranje žilne stene med preostali plasti. Za prikaz disekcij vratnih arterij se poslužujemo uporabe metod magnetno resonančne angiografije (MRA) in računalniško tomografske angiografije (CTA). MRA je metoda, s katero prikažemo žilje z ali brez uporabe kontrastnega sredstva. Za prikaz žilja lahko uporabimo tehniko preleta ali fazno kontrastno angiografijo. Druga metoda, ki jo uporabljamo za prikaz disekcij pa je CTA, pri kateri pa je prisotno ionizirajoče sevanje in nujna uporaba jodovega kontrastnega sredstva. Namen: Namen diplomske naloge je ugotoviti, katera slikovna diagnostika je metoda izbora za prikaz disekcije vratne arterije, ter predstaviti prednosti in slabosti CTA in MRA metode. Metode dela: V retrospektivni pregled smo vključili 17 pacientov, kateri so imeli opravljeni CTA in MRA preiskavi. Primerjali smo CTA in MRA preiskave pacientov, ki so imeli po prvotno opravljeni CTA preiskavi postavljeno diagnozo ali pa sum na disekcijo v področju vratnih arterij. Rezultati: Po opravljeni CTA preiskavi je bil v 10 primerih postavljen sum na disekcijo vratnih arterij, disekcija je bila potrjena v 6 primerih, v 1 primeru pa ni bilo postavljene ne diagnoze ne suma na disekcijo. CTA metoda je poleg disekcije v 5 primerih prikazala tudi prisotne zožitve. MRA metoda je ugotovila prisotnost disekcije v 12 primerih. Pri 2 primerih so poleg disekcije odkrili še tromb in zožitev, pri 4 pacientih ishemične spremembe, pri 2 primerih tromb ter pri 2 zožitev. V enem primeru so poleg zožitve odkrili tudi psevdoanevrizmo. V 3 primerih, kjer disekcija ni bila potrjena, niso našli dodatnih patologij. Pri enem primeru, kjer ni bilo potrjene disekcije so ugotovili flap, ter v enem primeru ugotovili ishemične spremembe. Razprava in zaključek: Ugotovili smo, da MRA metoda bolje prikaže disekcije vratnih arterij, hkrati pa nam bolje prikaže zožitve arterij, ishemične spremembe v možganovini, trombe in psevdoanevrizme kot CTA. Vendar pa je za primarno diagnostično preiskavo CTA metoda še vedno zlati standard, saj je preiskava dostopnejša, hitrejša ter ima manj kontraindikacij za izvedbo. Tako smo mnenja, da se MRA metoda izkaže kot zelo dobra dopolnilna metoda, ki lahko potrdi ali pa zavrže sum na morebitno disekcijo.

• Jezik: Slovenski jezik
• Ključne besede: magnetno resonančna angiografija, računalniško tomografska angiografija, disekcija, vratne arterije, tehnika preleta, fazno kontrastna angiografija
• Vrsta gradiva: Diplomsko delo/naloga
• Organizacija: ZF - Zdravstvena fakulteta
• Leto izida: 2019
• PID: 20.500.12556/RUL-110428
• COBISS.SI-ID: 5685355
• Datum objave v RUL: 14.09.2019

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Comparison of magnetic resonance angiography and computed tomographic angiography for evaluation of cervical artery dissection : diploma work

Izvleček

Introduction: Dissection is a tear in the lining of an artery, which allows blood to enter between the layers of a blood vessel. For evaluation of cervical artery dissection, we can use magnetic resonance angiography (MRA) and computed tomographic angiography (CTA). MRA is a method, which shows blood vessels with or without the use of a contrast agent. We can use time of flight technique or phase contrast angiography. Another method, used to represent dissections is CTA, where ionizing radiation and the necessary use of the iodine contrast agent are present. Purpose: The aim of this study is to determine which imaging diagnostics is the method of choice for displaying the cervical artery dissection, and to present the advantages and disadvantages of the CTA and MRA method. Methods: In a retrospective study, we included 17 patients who had performed MRA and CTA exams. We compared CTA and MRA exams of patients who had a diagnosis or suspicion of a dissection in the area of the cervical arteries after the initial CTA was performed. Results: After the CTA exam, 10 cases were suspected of dissection of the cervical arteries, the dissection was confirmed in 6 cases, and in 1 case there was no diagnosis or suspicion of dissection. CTA method also showed narrowing of blood vessels in 5 cases. The MRA method confirmed the presence of dissection in 12 cases. In 2 cases, in addition to dissection, thrombus and narrowing of vessels were also found, in 4 patients, ischemic changes, in 2 cases thrombus, and in 2 cases narrowing. In one case, besides the narrowing, pseudoaneurysm was also detected. In 3 cases where dissection was not confirmed, no additional pathologies were found. In 1 case where dissection was no confirmed, flap was detected, and in the other case, ischemic changes were observed. Discussion and conclusion: We found out, that the MRA demonstrates the dissection of the cervical arteries better than the CTA. It is also better at showing us the narrowing of the arteries, ischemic changes in the brain, thrombi and pseudoaneurysms. However, for the primary diagnostic exam, the CTA method is still a gold standard since the examination is more accessible, faster and has less contraindications. We think that the MRA turns out to be a very good complementary method that can confirm or reject a suspicion of a possible dissection.

• Ključne besede: magnetic resonance angiography, computed tomographic angigography, dissection, cervical arteries, time of flight, phase contrast angiography