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МРТ- и КТ-венография в диагностике гемодинамических нарушений у пациентов с хроническими заболеваниями вен нижних конечностей Часть I. Возможности МРТ-исследований в визуализации сосудистого русла нижних конечностей

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Несмотря на то что в России большинство сосудистых хирургов крайне редко используют в своей ежедневной практике магнитно-резонансную томографию (Magnetic Resonance Imaging - MRI), на сегодня интерес к этому методу визуализации среди специалистов в мире неуклонно возрастает. Это связано со стремлением клиницистов иметь еще один неинвазивной метод диагностики гемодинамических нарушений как артериального (Magnetic Resonance Angiography - MRA), так и венозного сосудистого русла (Magnetic Resonance Venography - MRV). Развитие этих методов сегодня связано с решением многих техническим задач, разработкой специальных импульсных последовательностей и методов постобработки полученного изображения. В данном обзоре литературы проводится анализ опубликованных научных данных по методологии проведения MRI применительно к сосудистой системе и выбору оптимальных режимов сканирования. Учитывая, что данный материал рассчитан в первую очередь на сосудистых хирургов и флебологов, а не радиологов, в первой части кратко изложены базовые основы понимания сути физических явлений, лежащих в основе получения MRI-изображения, без чего невозможен вдумчивый анализ преимуществ и недостатков MRA и поиск наиболее оптимального режима сканирования для проведения MRV. Учитывая, постоянное стремление клиницистов к самообразованию, представляется, что эта часть представленного материала не будет сложной для восприятия. При описании разработанных бесконтрастных и контрастных методов проведения MRA уделено внимание ставшим традиционными методам обработки изображения в 20-режиме (TOF, PC) с использованием импульсных последовательностей: спин-эхо (SE), мульти-эхо (SE Т2), турбо спин-эхо (TSE), быстрого улучшения спин-эхо (Fast Advanced Spin Echo - FASE), градиентного эхо (Gradient Echo - GE, GRE) и восстановления с инверсией (Inversion Recovery - IR). Кроме того, сделан акцент на самых современных решениях, включающих: мультиплантарное переформатирование (multiplantar reformatting - MPR), проекции максимальной интенсивности (maximum intensity projection - MIP), субволюмную максимальную интенсивность, поверхностный рендеринг (surface rendering - SR), объемный рендеринг (volume rendering - VR) и виртуальную внутрипросветную эндоскопию (virtual intraluminal endoscopy - VIE). В отношении всех используемых на сегодня методов проведения MRA показана специфичность и информативность с подробным анализом преимуществ и недостатков. Показаны нюансы понимания полученной ангиографической картинки в Т1- и Т2-взвешенном изображении и феноменов “яркой крови” и “черной крови”. Учитывая, что в отечественной литературе информация о возможностях использования MRI в диагностике гемодинамических нарушений у пациентов с патологией сосудистого русла отсутствует или в лучшем случае носит характер краткого упоминания, представляется, что данный материал является актуальным и вызовет определенный интерес со стороны различных специалистов. Особый интерес представляет потенциальная возможность использования методов проведения бесконтрастной и контрастной MRA в изучении венозной патологии нижних конечностей и таза, особенно, что касается своевременной и точной диагностики глубокого венозного тромбоза (Deep Vein Thrombosis - DVT) и венозного тромбоэмболизма (Venous Thrombo-Embolism - VTE), которые в структуре пациентов с хроническими заболеваниями вен нижних конечностей (Chronic Venous Disorders - CVD) занимают особое положение.

Ключевые слова:
магнитно-резонансная томография, магнитно-резонансная ангиография, магнитно-резонансная флебография, компьютерная томография, компьютерно-томографическая флебография, хронические заболевания вен, диагностика тромбоза вен нижних конечностей, варикозное расширение вен, анатомическое строение вен нижних конечностей, magnetic resonance imaging, magnetic resonance angiography, magnetic resonance venogr

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MRI and CT venography in the diagnosis of hemodynamic disorders in patients suffering from the lower extremities veins chronic diseases Part I. Possibilities of MRI in visualization of the vascular blood flow of the lower extremities

Despite the fact that most vascular surgeons in Russia rarely use magnetic resonance imaging (MRI) in their daily practice, today interest in this method of imaging among specialists in the world is steadily increasing. This is due to the desire of clinicians to have another non - invasive method for diagnosing hemodynamic disorders of both the arterial (Magnetic Resonance Angiography - MRA) and venous vascular bed (Magnetic Resonance Venography - VRA). The development of these methods today is associated with the solution of many technical problems, the development of special pulse sequences and post-processing methods for the resulting image. This literature review analyzes published scientific data on the methodology of MRI in relation to the vascular system and the choice of optimal scanning modes. Taking into consideration the fact that this material is intended primarily for vascular surgeons and phlebologists, and not radiologists, the first part summarizes the basic under-standing of the physical phenomena underlying the MRI image, without which a thoughtful analysis of the advantages and disadvantages of MR-Angiography and the search for the most optimal scanning mode for MR-Venography is not possible. Based on the constant desire of clinicians to be self-educated, it seems that this part of the presented material will not be difficult to understand. When describing the developed contrast-free and contrast-free MRA methods, attention is paid to the traditional methods of image processing in 2D mode (TOF, PC) using pulse sequences: spin echo (SE), multi-echo (SE T2), turbo spin echo (TSE), fast Advanced Spin Echo (fast Advanced Spin Echo-FASE), gradient echo (Gradient Echo-GE, GRE) and inversion recovery (Inversion Recovery-IR). In addition, the focus is on the most modern solutions, including: multiplantar reformatting (MPR), maximum intensity projection (MIP), subvolume maximum intensity, surface rendering (SR), volume rendering (VR) and virtual intraluminal endoscopy (VIE). For all the methods used today, MR-Angiography is shown to be specific and informative, with a detailed analysis of the advantages and disadvantages. The nuances of understanding the resulting angiographic image in T1 and T2-weighted images and the phenomena of “bright blood” and “black blood” are shown. Since the absence of information or a brief mention only about the possibilities of using MRI in the diagnosis of hemodynamic disorders in patients with vascular pathology in Russian scientific literature it seems that this material is relevant and will arouse some interest from various specialists. Of particular interest is the potential use of contrast-free and contrast - free MR Angiography in the study of venous pathology of the lower extremities and pelvis, especially with regard to timely and accurate diagnosis of deep venous thrombosis (deep Vein Thrombosis-DVT) and venous thromboembolism (Venous Thrombosis - Embolism - VTE), which occupy a special position in the structure of patients with chronic venous Disorders of the lower extremities (Chronic Venous Disorders-CVD).

Keywords:
магнитно-резонансная томография, магнитно-резонансная ангиография, магнитно-резонансная флебография, компьютерная томография, компьютерно-томографическая флебография, хронические заболевания вен, диагностика тромбоза вен нижних конечностей, варикозное расширение вен, анатомическое строение вен нижних конечностей, magnetic resonance imaging, magnetic resonance angiography, magnetic resonance venogr