MRT-Diagnostik im Rahmen der Abklärung phlebologischer Krankheitsbilder

Zusammenfassung

Die aszendierende Phlebographie der Beinvenen stellt aktuell immer noch den Goldstandard für die Beurteilung des oberflächlichen und tiefen Venensystems der unteren Extremität dar und besitzt als diagnostisches Werkzeug für den Nachweis einer tiefen Beinvenenthrombose (TVT) einen hohen Stellenwert. Die nichtinvasive Duplexsonographie gewinnt zunehmend an Bedeutung und wird vorwiegend als erstes apparatives Diagnoseverfahren bei der Fragestellung einer TVT eingesetzt. Trotz bekannter Nachteile wie der Belastung des Patienten durch ionisierende Strahlung und der Gefahr kontrastmittelinduzierter Nebenwirkungen findet die konventionelle Phlebographie bei unklaren duplexsonographischen Befunden nach wie vor eine breite Anwendung. Die Magnetresonanztomographie (MRT) hat in den letzten Jahren erhebliche Fortschritte in ihrer technischen Weiterentwicklung erfahren. Es scheint, dass die moderne MR-Phlebographie mit ihrer Darstellung des venösen Gefäßsystems (und hier speziell bei der Diagnosestellung einer TVT) die konventionelle Phlebographie zurückdrängen kann. Aber auch die suffiziente Beurteilung der Weichteilverhältnisse zur Einschätzung eines postthrombotischen Syndroms und der chronischen venösen Insuffizienz (CVI) ist mit der MRT möglich.

Summary

Conventional venography is still acknowledged as the gold standard for the assessment of the deep and superficial venous system of the lower extremities and it is of great significance as a therapeutic tool for the diagnosis of deep venous thrombosis (DVT). Non-invasive duplex sonography has gained acceptance and in most institutions it is mainly used as the initial diagnostic tool for the assessment of a DVT. Despite of known disadvantages, like the exposure to ionizing radiation and complications associated with the use of iodinated contrast material, there is still a widespread use of conventional venography if duplex sonography results remain questionable. Throughout the last few years the technical development of magnetic resonance imaging has experienced considerable progress. It seems that modern MR-venography with it’s capacity to depict the venous vasculature (especially for the diagnosis of a DVT) is able to force back conventional venography. Furthermore magnetic resonance imaging provides visualization of soft tissue changes and contributes important information to monitor postthrombotic changes and to assess the grade of chronic venous insufficiency (CVI).

Résumé

La phlébologie conventionelle du système vasculaire des veines de jambes représente encore aujourd’hui la méthode standard pour juger soit les couches superficielles soit profondes du système veinaire des extrémités bas. En tant qu’outil de diagnostique d’une thrombose veinaire profonde (TVP) on lui accorde une grande importance. La sonographie duplex non-invasive gagne de plus en plus d’importance, surtout comme première méthode de diagnostique dans le cadre d’une TVP. Malgré les effets négatifs connus pour le client, p. ex. les radiations nocives et les effets secondaires nuisibles provoqués par les substances de contraste, la phlébographie traditionelle – tout en fournissant des résultats redoutables – se réjouit d’une grande acceptance. Ces dernières années la tomographie magnétique a connus des progrès considérables au niveau du procédé technique. Il semble que la phlébographie à la base de la tomographie magnétique moderne et sa possibilité de représenter le système vasculaire des veines (particulièrement dans le cadre de diagnostique d’une thrombose profonde venaire) peut remplacer la phlébologie traditionelle. En plus, la tomographie magnétique permet une visualisation et evaluation suffisante des changements dans les parties molles a cause d’un syndrome postthrombotique ou d’une insuffisance chronique de veines (ICV).

La diagnostique tomographie magnétique dans le cadre des maladies phlébologiques

Schlüsselwörter

MR-Phlebographie - kontrastmittelverstärkte MR-Phlebographie - tiefe Beinvenenthrombose (TVT) - chronische venöse Insuffizienz (CVI) - postthrombotisches Syndrom

Keywords

MR-venography - contrast-enhanced MR-venography - deep venous thrombosis (DVT) - chronic venous insufficiency (CVI) - postthrombotic changes

Mots clés

Phlébographie tomographie magnétique - thrombose veinaire profonde (TVP) - insufficience chronique de veines (ICV) - syndrome postthrombotique

• Literatur

• 1 Baxter GM. The role of ultrasound in deep venous thrombosis. Clin Radiol 1997; 52: 1-3.
• 2 Bollinger A, Isenring G, Franzeck UK. Lymphatic microangiopathy: a complication of severe chronic venous incompetence (CVI). Lymphology 1982; 15: 60-5.
• 3 Bettmann MA, Robbins A, Braun SD, Wetzner S, Dunnick NR, Finkelstein J. Contrast venography of the leg: diagnostic efficacy, tolerance, and complication rates with ionic and nonionic contrast media. Radiology 1987; 165: 113-6.
• 4 Catalano C, Pavone P, Laghi A, Scipioni A, Fanelli F, Assael FG, Grossi A, Venosi S, Passariello R. Role of MR venography in the evaluation of deep venous thrombosis. Acta Radiol 1997; 38: 907-12.
• 5 Comerota AJ, Katz ML, Grossi RJ, White JV, Czeredarczuk M, Bowman G, DeSai S, Vujic I. The comparative value of noninvasive testing for diagnosis and surveillance of deep vein thrombosis. J Vasc Surg 1988; 7: 40-9.
• 6 Cronan JJ. Contemporary venous imaging. Cardiovasc Intervent Radiol. 1991; 14: 87-97.
• 7 Erdman WA, Weinreb JC, Cohen JM, Buja LM, Chaney C, Peshock RM. Venous thrombosis: clinical and experimental MR imaging. Radiology 1986; 161: 233-8.
• 8 Erdman WA, Jayson HT, Redman HC, Miller GL, Parkey RW, Peshock RW. Deep venous thrombosis of extremities: role of MR imaging in the diagnosis. Radiology 1990; 174: 425-31.
• 9 Evans AJ, Sostman HD, Knelson MH, Spritzer CE, Newman GE, Paine SS, Beam CA. 1992 ARRS Executive Council Award. Detection of deep venous thrombosis: prospective comparison of MR imaging with contrast venography. AJR Am J Roentgenol 1993; 161: 131-9.
• 10 Evans AJ, Sostman HD, Witty LA, Paulson EK, Spritzer CE, Hertzberg BS, Carroll BA, Tapson VF, Saltzman HA, DeLong DM. Detection of deep venous thrombosis: prospective comparison of MR imaging and sonography. J Magn Reson Imaging 1996; 6: 44-51.
• 11 Jensen AD, Borris LC, Christiansen TM, Lundorf E. Accuracy of magnetic resonance imaging in the diagnosis of deep vein thrombosis in asymptomatic patients with injuries of the lower extremity. A pilot study. Thromb Res 2001; 101: 423-6.
• 12 Gmelin E, Rosenthal M, Schmeller W, Tichy P, Busch D. Computed tomography and magnetic resonance tomography of the lower leg in chronic venous insufficiency. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1989; 151: 50-6.
• 13 Grover T, Singer JR. NMR spin-echo-flow measurements. J Appl Physiol 1971; 42: 938-41.
• 14 Hansen ME, Spritzer CE, Sostman HD. Assessing the patency of mediastinal and thoracic inlet veins: value of MR imaging. AJR Am J Roentgenol 1990; 155: 1177-82.
• 15 Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation 1996; 93: 2212-45.
• 16 Holtz DJ, Debatin JF, McKinnon GC, Unterweger M, Wildermuth S, von Schulthess GK, Fuchs WA. MR venography of the calf: value of flow-enhanced time-of-flight echoplanar imaging. AJR Am J Roentgenol 1996; 166: 663-8.
• 17 Kakkar VV. Deep vein thrombosis. Detection and prevention. Circulation 1975; 51: 8-19.
• 18 Laissy JP, Cinqualbre A, Loshkajian A, Henry-Feugeas MC, Crestani B, Riquelme C, Schouman-Claeys E. Assessment of deep venous thrombosis in the lower limbs and pelvis: MR venography versus duplex Doppler sonography. Am J Roentgenol 1996; 167: 971-5.
• 19 Landefeld CS, McGuire E, Cohen AM. Clinical findings associated with acute proximal deep vein thrombosis: a basis for quantifying clinical judgment. Am J Med 1990; 88: 382-8.
• 20 Lanzer P, Gross GM, Keller FS, Pohost GM. Sequential 2D inflow venography: initial clinical observations. Magn Reson Med 1991; 19: 470-6.
• 21 Lebowitz JA, Rofsky NM, Krinsky GA, Weinreb JC. Gadolinium-enhanced body MR venography with subtraction technique. Am J Roentgenol 1997; 169: 755-8.
• 22 Lensing AW, Prandoni P, Buller HR, Casara D, Cogo A, ten Cate JW. Lower extremity venography with iohexol: results and complications. Radiology 1990; 177: 503-5.
• 23 List-Hellwig E, Meents H. Magnetic resonance imaging and computed tomography in advanced chronic venous insufficiency. Curr Probl Dermatol 1999; 27: 109-13.
• 24 Montgomery KD, Potter HG, Helfet DL. Magnetic resonance venography to evaluate the deep venous system of the pelvis in patients who have an acetabular fracture. J Bone Joint Surg Am 1995; 77: 1639-49.
• 25 Moody AR, Pollock JG, O’Connor AR, Bagnall M. Lower-limb deep venous thrombosis: direct MR imaging of the thrombus. Radiology 1998; 209: 349-55.
• 26 Morse O, Singer JR. Blood velocity measurements in intact subjects. Science 1970; 170: 440-1.
• 27 Peschen M, Vanscheidt W, Sigmund G, Behrens JO, Schopf E. Computerized tomography and magnetic resonance tomography studies before and after para-tibial fasciotomy. Hautarzt 1996; 47: 521-5.
• 28 Rabinov K, Paulin S. Venography of the lower extremities. In: Abrams HL. (ed). Angiography: Vascular and interventional radiology. 3rd edition. Boston: Little Brown & Co; 1983: 1877-923.
• 29 Ruehm SG, Wiesner W, Debatin JF. Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience. Radiology 2000; 215: 421-7.
• 30 Ruehm SG, Zimny K, Debatin JF. Direct contrast-enhanced 3D MR venography. Eur Radiol 2001; 11: 102-12.
• 31 Sandler DA, Martin JF, Duncan JS, Blake GM, Ward P, Ramsay LE, Lamont AC, Ross B, Sherriff S, Walton L. Diagnosis of deep-vein thrombosis: comparison of clinical evaluation, ultrasound, plethysmography, and venoscan with X-ray venogram. Lancet 1984; 29: 716-9.
• 32 Shehadi WH, Toniolo G. Adverse reactions to contrast media: a report from the Committee on Safety of Contrast Media of the International Society of Radiology. Radiology 1980; 137: 299-302.
• 33 Shehadi WH. Contrast media adverse reactions: occurrence, recurrence, and distribution patterns. Radiology 1982; 143: 11-7.
• 34 Singer JR. Blood flow rates by nuclear magnetic resonance. Science 1959; 130.
• 35 Spritzer CE, Sussman SK, Blinder RA, Saeed M, Herfkens RJ. Deep venous thrombosis evaluation with limited-flip-angle, gradientrefocused MR imaging: preliminary experience. Radiology 1988; 166: 371-5.
• 36 Spritzer CE, Norconk Jr JJ, Sostman HD, Coleman RE. Detection of deep venous thrombosis by magnetic resonance imaging. Chest 1993; 104: 54-60.
• 37 Spritzer CE, Arata MA, Freed KS. Isolated pelvic deep venous thrombosis: relative frequency as detected with MR imaging. Radiology 2001; 219: 521-5.
• 38 Wehrli FW, Shimakawa A, Gullberg GT, MacFall JR. Time-of-flight MR flow imaging: selective saturation recovery with gradient refocusing. Radiology 160: 781-5.
• 39 Venta LA, Venta ER, Mumford LM. Value of diagnostic tests for deep venous thrombosis: a decision analysis model. Radiology 1990; 174: 433-9.
• 40 Yoshizako T, Sugimura K, Kawamitsu H, Yoshikawa K. Two-dimensional time-of-flight MR venography: assessment with detection of chronic deep venous thrombosis in combination with magnetization transfer contrast. J Comput Assist Tomogr 1996; 20: 957-64.