三维飞行时间磁共振血管成像作为颅内动脉狭窄和闭塞性疾病支架置入前有效筛查工具的可能性(英文)

Possibility of three-dimensional time-of-flight magnetic resonance angiography as a reliable screening tool for evaluation of intracranial vascular stenosis and occlusive disease prior to stent implantation

目的:评估三维飞行时间磁共振血管成像(3D time-of-flight magnetic resonance angiography,3D TOF MRA)是否可以作为一种可靠的筛检工具用于术前评估颅内血管狭窄和闭塞性疾病。方法:2007-03/2008-04首都医科大学附属朝阳医院共有33例患者怀疑存在颅内动脉狭窄,均同时接受了3DTOFMRA和数字减影血管成像(digital subtraction angiography,DSA)检查。两位对患者血管狭窄程度、病史及其他临床资料不知情的影像科医生分析了33例患者的363个血管片段(双侧的颈内动脉、大脑前动脉、大脑中动脉、大脑后动脉、椎动脉和基底动脉)。狭窄程度分为30%～49%,50%～69%,70%～99%及100%。对于各类的狭窄,3DTOFMRA与DSA相比的敏感度、特异度、阳性预测价值、阴性预测价值、κ值及P值分别给予计算。结果:总共发现42处病变血管片段,对于50%～69%的狭窄来说,3DTOFMRA的敏感度是100%,特异度是96.8%,阳性预测价值是62.1%,阴性预测价值是100%,κ值是0.751,P值0.000;对于70%～99%的狭窄来说,分别是100%,98.6%,70.6%,100%,0.821和0.000;对于100%的狭窄(闭塞)来说,分别是100%,100%,100%,100%,1.000和0.000;对于30%～49%的狭窄来说,分别是25.0%,99.7%,66.7%,98.3%,0.356和0.000。结论:鉴于对狭窄程度为100%、70%～99%或者50%～69%颅内动脉狭窄来说,3DTOFMRA与DSA相比有着高度的敏感度及特异度,可以认为3DTOFMRA是颅内动脉狭窄支架置入前一种有效的筛查手段。

AIM： To investigate whether three-dimensional time-of-flight magnetic resonance angiography （3D TOF MRA） can be used as a reliable screening tool for evaluation of intracranial vascular stenosis and occlusive disease before stent implantation. METHODS： Thirty-three patients with suspected intracranial arterial stenosis received 3D TOF MRA and digital subtraction angiography （DSA） examinations in Chaoyang Hospital Affiliated to Capital Medical University between March 2007 and April 2008, and were included for this study. Two physicians blindly estimated stenosis, patient history, and clinical information of 363 vascular segments from 33 patients, including bilateral internal carotid artery （ICA）, anterior cerebral artery （ACA）, middle cerebral artery （MCA）, posterior cerebral artery （PCA）, vertebral artery, and basilar artery （BA）. Stenosis was categorized as 30%-49%, 50% 69%, 70% 99%, and 100%. For each kind of stenosis, sensitivity, specificity, positive predictive value, negative predictive value,k and P values of MRA were calculated, respectively, as compared to DSA. RESULTS： A total of 42 diseased vascular segments were identified. Compared to DSA, for intracranial stenosis 50% 69%, 3D TOF MRA showed sensitivity 100%, specificity 96.8%, positive predictive value 62.1%, negative predictive value 100%, k value 0.751, and P value 0.000; For intracranial stenosis 70%-99%, the corresponding value was 100%, 98.6%, 70.6%, 100%, 0.821, and 0.000, respectively; For intracranial stenosis 30%-49%, it was 25.0%, 99.7%, 66.7%, 98.3%, 0.356, and 0.000, respectively. CONCLUSION： For high sensitivity and specificity to intracranial stenosis 100%, 70% 99%, or 50%-69%, compared to DSA, 3D TOF MRA is a reliable screening tool for preoperational evaluation of intracranial vascular stenosis and occlusive disease.