Dokument: Kontrastmittelfreie balanced Steady-State Free Precession 3D-MR-Angiographie an Nieren- und Nierentransplantatarterien
| Titel: | Kontrastmittelfreie balanced Steady-State Free Precession 3D-MR-Angiographie an Nieren- und Nierentransplantatarterien | |||||||
| Weiterer Titel: | Contrast agent free balanced Steady-State Free Precession 3D-MR-Angiography in renal and renal graft arteries | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=23315 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20121218-114353-6 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Freitag, Sonja-Marie [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Blondin, Dirk [Gutachter] Prof. Dr. med. Giessing [Gutachter] | |||||||
| Stichwörter: | bSSFP, 3T, 1,5T, Nierentransplantatarterien, Nierenarterien, Stenose, Gadolinium, NSF, Kontrastmittel, Vergleich | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Patienten mit eingeschränkter Nierenfunktion sollten möglichst ohne Kontrastmittel untersucht werden. Der Einsatz jodhaltiger Kontrastmittel kann zu einer kontrastmittelinduzierten Nephropathie (KIN) führen, der Einsatz gadoliniumhaltiger MRT-Kontrastmittel bedingt das Risiko einer Nephrogenen Systemischen Fibrose (NSF).
In dieser Arbeit wurde der diagnostische Wert der kontrastmittelfreien balanced Steady-State Free Precession-Magnetresonanzangiographie (bSSFP-MRA) für die Darstellung und Quantifizierung möglicher Stenosen in Nieren- und Nierentransplantatarterien untersucht. Dafür wurde die bSSFP-MRA in einer Studie mit 20 nierentransplantierten Patienten, bei denen dopplersonographisch der Verdacht auf Transplantatarterienstenose bestand, bei 1,5T ausgeführt. Die Ergebnisse wurden mit dem Goldstandard der Digitalen Subtraktionsangiographie (DSA) hinsichtlich der Erkennung und Quantifizierung von Stenosen verglichen. Da in vielen Kliniken inzwischen immer häufiger 3T-MR-Tomographen zum Einsatz kommen, wurde die bSSFP-MRA in einer weiteren Studie an nativen Nieren 20 gesunder Probanden bei 1,5T und 3T verglichen. Das relative Signal-Rausch-Verhältnis (SNR) und Kontrast-Rausch-Verhältnis (CNR) und die subjektive Bildqualität wurden untersucht. Im Vergleich zur DSA wurden mit der bSSFP-MRA alle Stenosen gefunden (Sensitivität 100%). Dabei bestand jedoch in 3 Fällen eine leichte Überschätzung der Stenose durch die SSFP-MRA (Spezifität 88%). Der Vergleich der bSSFP-MRA bei 1,5T und 3T ergab in der subjektiven Bildqualität eine Überlegenheit der bSSFP-MRA bei 3T in peripher gelegenen Abschnitten der Nierenarterien. Für die relative SNR und CNR ergaben sich bei 3T signifikant höhere Werte. Die bSSFP-MRA ist eine vielversprechende, kontrastmittelfreie Methode zur Untersuchung von Nierenarterien, zu deren Stellenwert und Optimierung weitere Studien erforderlich sind. Sie ist sowohl bei nativen als auch bei transplantierten Nierenarterien stabil einsetzbar und kann bei dopplersonographischem Verdacht auf Gefäßstenosen als Screeninguntersuchung eingesetzt werden. So kann sie niereninsuffizienten Patienten eine unnötige Belastung durch kontrastmittelgestützte Untersuchungen ersparen. Patients with reduced renal function should preferably be examined without contrast agents. The use of contrast media containing iodine can cause a contrast-induced nephropathy (CIN), the use of MRI contrast media containing Gadolinium imports the risk of a nephrogenic systemic fibrosis (NSF). This dissertation analysed the diagnostic value of the contrast agent free balanced Steady-State Free Precession-MR-Angiography (bSSFP-MRA) for depiction and quantification of possible stenosis in renal and renal graft arteries. Therefore the bSSFP-MRA at 1,5T was performed in a survey in 20 patients with renal grafts in which doppler sonography gave suspicion of a stenosis of the renal transplant artery. The results concerning depiction and quantification of stenosis were compared to the gold standard digital subtraction angiography (DSA). Since today in many hospitals 3T-MRI is used the bSSFP-MRA was examined in a second survey in native renal arteries in 20 healthy probands at 1,5 and 3T. Relative signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) and subjective quality of the images were analysed. Compared to the DSA bSSFP-MRA found all stenoses (Sensitivity 100%). In 3 cases the bSSFP overestimated the stenosis (Specificity 88%). The comparison of bSSFP-MRA at 1,5 and 3T showed a superiority of subjective image quality at 3T for peripheric parts of the renal arteries. The values of relative SNR and CNR were significantly higher at 3T. The bSSFP-MRA is a promising contrast agent free technique for the examination of renal arteries which has to be further analysed to determine its value and to optimize it. It can be used both in native renal and transplant renal arteries as a screening technique where doppler sonography caused the suspicion of a stenosis. Therefore it can spare patients suffering from renal failure the needless use of contrast agents. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Bezug: | 2007-2009 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 18.12.2012 | |||||||
| Dateien geändert am: | 18.12.2012 | |||||||
| Promotionsantrag am: | 12.09.2012 | |||||||
| Datum der Promotion: | 04.12.2012 |
