MRI与DSA对颈动脉支架置入术适应证选择的比较

Comparison of cardiovascular MRI and DSA in the selection of stent-treatment for carotid atherosclerosis patients

目的 比较3.0T磁共振（MRI）和数字减影血管造影（DSA）对颈动脉粥样硬化患者支架置入术适应证选择的效能差异.方法 收集2009年1月至2010年12月卫生部北京医院神经外科就诊的46例初发或复发脑缺血疾病的患者,超声检查发现颈动脉粥样硬化斑块后分别行颈动脉MRI及DSA检查.比较两种方法对血管狭窄程度、溃疡斑块的检出和对手术适应证确定的效能差异.结果 共92支颈动脉,除3支血管为支架置入后,症状性血管组25支血管,无症状血管组64支血管.MRI和DSA对颈动脉管腔狭窄的判断具有很好的一致性（Kappa值为0.882）;对溃疡斑块检出的差异有统计学意义（P〈0.01）;对手术适应证的确定,症状组的差异无统计学意义（分别为14支和13支血管,P〉0.05）,无症状组的差异具有统计学意义（分别为22支和14支血管,P＜0.05）.在接受手术的14例患者中2例的手术依据仅参照MRI.MRI发现37支血管有斑块内出血,71支有斑块内钙化,而DSA未能检出.结论 与DSA相比,MRI可以更好地检出符合手术适应证要求的血管.

Objective To compare the efficacy of cardiovascular MRI and DSA in stent-treatment selection for patients with carotid atherosclerosis.Methods Forty-six patients with carotid plaque detected by ultrasound were enrolled in this study.Carotid plaque MRI and DSA was performed.Images were evaluated for luminal stenosis（NASCET standard）, fibrous cap rupture, intra-plaque hemorrhage and calcification.Kappa value and paired chi-square test were used for the statistical analysis.Results These 92 carotid arteries were divided into two groups, that were the symptomatic artery group with 25 vessels and asymptomatic artery group with 64 vessels, and the other 3 arteries were excluded due to stent placement.There was good concordance between the degree of stenosis measured by MRI and DSA （Kappa value 0.882）.There was significant difference in detecting FC rupture by two modalities （P〈0.01）.As to the indication selection for stent treatment by two modalities, there was significant difference for asymptomatic group（22 vessels by MRI and 14 vessels by DSA, P〈0.05）, neither did the symptomatic group.There were two patients, among those 14 who underwent the stent treatment, that decided stent treatment only rely on the FC rupture detected by MRI.Furthermore, MRI detected 37 vessels with intra-plaque hemorrhage and 71 vessels with calcification in the plaque.Conclusion MRI was much more suitable for the selection of stent treatment for patients with carotid atherosclerosis as compared with DSA.