- 期刊
3D TOF磁振血管造影於急性休克病患之警訊－病例報告
The Warning Sign of 3D TOF Magnetic Resonance Angiography for a Shock Attack Patient Case Report
摘要
我們在此報告一非常罕見病例，在無需顯影劑的磁振血管造影三維飛躍時間技術，檢查中呈現無血管訊號之影像，臨床放射師根據經驗及學識原理判斷成因為血液流速過慢，頭部無法得到正常血液灌流並發現病人已處休克狀態，同時緊急呼叫院內急救小組進行心肺復甦術。根據電腦斷層及磁振造影影像診斷為基底動脈夾層剝離引發蜘蛛網膜下腔出血，造成自身頭部血管痙攣，血管管腔出現暫時性之狹窄，以致難以順利供應血流而產生自發性休克。由於磁振照影檢查時間較長，隨時注意病人可能發生之狀況，實為臨床放設師須注重之課題。本篇主要目的是藉由我們的臨床經驗，提供臨床放射師參考，對於一般患者或住院病人如確認飛躍時間波序相關參數設定無誤時，應立即停止檢查並馬上觀測病人狀況，尋求相關協助以維護病患安全。對於心肺復甦術後病人之追蹤，因顱內腫脹磁振血管造影三維飛躍時間技術可能表現出無血管訊號影像，使用對比劑磁振血管照影為較佳之選擇。
並列摘要
We report a rare case in the non-enhance three dimensional time of flight magnetic resonance angiography (3D-TOF MRA) show the no blood flow signal of vessel image, that radiological technologist according to experience and basic magnetic resonance image (MRI) physic knowledge judge of too slow blood flow to made the patient's brain has not enough received blood perfusion supply and cause the patient sudden onset of cardiac arrest. Hence, the stuff call emergency medical service of our hospital for cardia-pulomonary resuscitation (CPR). According to computed tomography (CT) and magnetic resonance images, show the basilar artery dissection aneurysm cause subarachnoid hemorrhage (SAH), intracranial vascular spasm and stenosis lead to brain blood perfusion insufficiency and induce patient shock. Because of long acquisition time of MRI examination, the radiological technologist should pay more attention on vital sign of patient. Our purpose was provided our experience to radiological technologist as a clinical reference, when imaging parameters of 3D-TOF pulse sequence was correct that the technologist should be stop the exam immediately and observe the vital sign of patient and call for help. If patient post C.P.R. with follow up MRI exam, brain swelling may cause no signal of vessels in 3D-TOF MRA images, we recommend the contrast enhanced magnetic resonance angiography (CE MRA) is a good choice for brain vessel survey.