MR快速多时相造影增强与时间飞跃血管成像在颈部血管疾病中诊断价值的对比研究

Comparison of the diagnostic value of rapid multiple-phase CE-MRA and TOF-MRA in cervical vascular diseases

目的 对比研究磁共振时间飞跃血管成像 (timeofflightmagneticresonanceangiograhy,TOF MRA)与快速多时相造影增强成像 (contrastenhancemagneticresonanceangiography ,CE MRA)在颈部血管疾病中的诊断价值。方法 临床怀疑颈部血管疾病患者 12 6例 ,同时进行颈部TOF MRA和CE MRA检查 ,所有病例均行DSA或者手术 ,并以此为金标准对TOF MRA和CE MRA的图像质量 [信噪比(SNR)、对比噪声比 (CNR)、伪影 ]、颈总动脉分叉区狭窄诊断 (准确性、特异性、敏感性 )及其在血管畸形中的诊断价值进行对比研究。结果 经DSA或手术证实阳性病例共 89例 (动脉瘤 3例、动静脉畸形 2例、颈总动脉分叉区动脉硬化狭窄 84例 ,共 12 2处狭窄 ) ,CE MRA在颈总动脉分叉区的SNR、CNR分别为 2 0 94± 2 5 7、11 10± 3 84 ,TOF MRA为 12 5 5± 1 71、2 70± 0 74 ,二者差异具有显著性意义 (t值分别为 13 36和 11 5 0 ,P值均 <0 0 0 1)。 12 6例的TOF MRA均出现伪影 ,而CE MRA未发现伪影。CE MRA对颈总动脉分叉区狭窄诊断特异性为 99 2 3% ,TOF MRA为 2 1 5 4 % ,二者差异具有显著性意义 (χ2 =12 0 85 ,P <0 0 0 1) ;CE MRA对颈总动脉分叉区狭窄诊断的敏感度为 90 88% ,TOF MRA为93 4 4 % 。

Objective To compare the diagnostic value of time of flight magnetic resonance angiography (TOF-MRA) and rapid multiple-phase contrast enhance MRA (CE-MRA) in cervical vascular diseases. Methods One hundred and twenty-six patients with suspected cervical vascular diseases were examined by using TOF-MRA and CE-MRA simultaneously.DSA or operation was performed in all cases,and the image qualities (signal noise ratio,contrast noise ratio,and artifacts) and the diagnostic values (accuracy,specificity,and sensitivity) of MRA in evaluating stenosis in the bifurcation of common carotid artery or vascular malformations were compared with the gold criteria of surgery or DSA. Results Of the 126 patients,89 were positive (3 cases of angioma,2 cases of arteriovenous malformation,and 84 cases of arteriosclerotic stenosis at bifurcation of common carotid artery,122 stenoses in total).The signal noise ratio and the contrast noise ratio in the bifurcation were 20.94±2.57 and 11.10±3.84 in CE-MRA and 12.55±1.71 and 2.70±0.74 in TOF-MRA,which showed significant difference between them (t_1=13.36,t_2=11.50 P<0.001).The artifacts of TOF-MRA was found in all 126 cases (100%),while no artifacts was found in CE-MRA.The diagnostic specificity to stenosis in bifurcation was 99.23% in CE-MRA,and 21.54% in TOF-MRA(χ 2=120.85,P<0.001).The diagnostic sensitivity to stenosis was 90.98% in CE-MRA and 93.44% in TOF-MRA (χ 2=0.086,P>0.05).The accuracy of TOF-MRA and CE-MRA was not significantly different in the stenosis less than 50% (χ 2=0.063,P>0.05),while the difference was statistically significant in the stenosis more than 50%(χ 2=65.40,P<0.001).Conclusion Rapid multiple-phase CE-MRA is superior to TOF-MRA in the image qualities,and in the specificity and accuracy for the evaluation of stenosis in carotid artery.Moreover,with the fast characteristics,CE-MRA has great value in the diagnosis of vessel malformation and can be considered as the first choice for cervical MRA examination,which may take the place of TOF-MRA.