斜矢状位高分辨三维黑血磁共振成像在粥样硬化颈动脉支架术前评估的应用价值

Oblique-Sagittal High-Resolution Three-Dimensional Black-Blood Magnetic Resonance Imaging in Preoperative Evaluation of Stenting in Atherosclerotic Carotid

目的探讨斜矢状位高分辨三维黑血磁共振成像(3D-BB-MRI)在粥样硬化颈动脉支架术前评估管腔狭窄及斑块形态方面的价值。资料与方法18例患者因至少一侧的症状性颈动脉粥样硬化病变进行颈动脉支架治疗。术前1周,对双侧颈总动脉远端、分叉处及颈内动脉近端进行斜矢状位高分辨二维黑血磁共振成像(2D-BB-MRI)及3D-BB-MRI扫描,同时对所有患者双侧颈动脉进行数字减影血管造影(DSA)检查。由2名放射科医师分别在2D-BB-MRI、3D-BB-MRI及DSA图像上评价颈动脉(颈总动脉远端、分叉处及颈内动脉近端)管腔最大狭窄程度(Max-stenosis)、斑块横向最大厚度(Max-TPT)、斑块纵向最大范围(Max-LPE),以DSA图像为标准分别分析2D-BB-MRI和3D-BB-MRI、DSA在评价Max-stenosis方面的差异,并对照分析2D-BB-MRI和3D-BB-MRI在显示Max-TPT、Max-LPE方面的差异。结果在评估Max-stenosis方面,2D-BB-MRI和3D-BB-MRI与DSA差异均无统计学意义(P=0.121及P=0.849),但3D-BB-MRI的显示结果更接近于DSA(79.80%±4.06%vs80.63%±4.67%,r=0.945,P=0.001),而2D-BB-MRI与DSA的相关性略低(77.75%±5.61%vs80.63%±4.67%,r=0.516,P=0.001)。对于Max-TPT的显示,2D-BB-MRI和3D-BB-MRI差异无统计学意义(P=0.450),而3D-BB-MRI所显示的Max-LPE明显大于2D-BB-MRI(16.74±5.54mmvs14.01±3.89mm,P=0.001)。结论作为一种无创的检查方法,3D-BB-MRI可以客观地显示粥样硬化颈动脉管腔最大狭窄程度、斑块厚度、累及范围,对颈动脉支架治疗手术具有很好的术前评估价值。

Purpose To evaluate the value of oblique-sagittal high-resolution three-dimensional black-blood magnetic resonance imaging （3D-BB-MRI） for assessing atherosclerotic carotid artery （CA） before carotid stenting （CS）. Materials and Methods A total of eighteen patients with symptomatic carotid arteries （18 carotid arteries） were performed CS due to atherosclerotic stenosis. The oblique-sagittal high-resolution two-dimensional black-blood magnetic resonance imaging （2D-BB-MRI）, 3D-BB-MRI and digital subtraction angiography （DSA） were respectively conducted within 1 week of the CEA. Two radiologists independently assessed maximum stenosis （Max-stenosis）, maximum transverse plaque thickness （Max-TPT） and location of maximal lumen stenosis, plaque rupture, degree of maximal lumen stenosis and maximum longitudinal plaque extension （Max-LPE）. Compared with matched images of DSA, the differences of ability in imaging these evaluation indexes between DSA, 2D-BB-MRI and 3D-BB-MRI were assessed. Results There was no difference in evaluating the Max-stenosis between DSA, 2D-BB-MRI and 3D-BB-MRI （P=-0.121 and P=-0.849）. However, the correlation of 2D-BB-MRI and DSA was lower [（77.75±5.61 ）% vs. （80.63±4.67）%, r=0.516, P=-0.001 ]. The results of 3D-BB-MRI was more closer to that of DSA [（79.80a=4.06）% vs. （80.63±4.67）%, r=0.945, P=0.001 ]. There was no difference in evaluating the Max-TPT between 2D-BB-MRI and 3D-BB-MRI （P=0.450）. However, the Max-LPE on 3D-BB-MRI was larger than that on the 2D-BB-MRI [（16.74±5.54）mm vs. （14.01±3.89）mm, P=0.001）. Conclusion As a noninvasive examination tool, 3D-BB- MRI can objectively show the Max-stenosis, Max-TPT and Max-LPE. 3D-BB-MRI can provide a good preoperative preparation for CS.