三种方法诊断大脑中动脉狭窄的对照研究

The diagnosis of middle cerebral artery stenosis: comparative study of three modalities

目的探讨高分辨率磁共振成像(HRMRI)在大脑中动脉狭窄或闭塞中的诊断价值。方法2012年4月—2013年3月收治47例缺血性脑血管病患者,先后行MRA、HRMRI及DSA检查,以DSA为金标准,结合MRA分析HRMRI对不同程度大脑中动脉狭窄的诊断价值。结果 47例患者有45支大脑中动脉在MRA、HRMRI和DSA上均发现管腔狭窄。HRMRI和DSA的符合率为82%;MRA较HRMRI诊断高估率为84%;HRMRI、DSA及MRA测得的狭窄率分别为0.75±0.16、0.71±0.17和0.93±0.13,HRMRI与DSA间差异无统计学意义(Z=-1.43,P=0.15),与MRA间的狭窄率差异有统计学意义(Z=-2.21,P=0.027)。以DSA为金标准,HRMRI对大脑中动脉狭窄或闭塞诊断的κ值为0.78。结论HRMRI在评估大脑中动脉狭窄方面与DSA具有良好一致性,且能避免MRA高估血管狭窄程度的缺陷,能较真实的反映脑动脉狭窄情况,有望成为诊断脑动脉狭窄的金标准。

[Abstract] Objective To evaluate high- resolution MRI （HRMRI） in diagnosing middle cerebral artery （MCA） stenosis or occlusion, and to compare HRMR with MRA and DSA. Methods A total of 47 patients with ischemic cerebrovascular disease underwent MRA, HRMRI and DSA examinations. Based on the results of DSA, used as the gold standard, and combined with MRA findings, the value of HRMRI in detecting MCA stenosis or occlusion was analyzed. Results The vascular stenosis was detected in 45 MCA segments in the 47 cases on MRA, HRMRI and DSA. The coincidence rate between HRMRI and DSA was 82%. The overestimation rate of MRA was 84% when compared with that of HRMRI. The MCA stenosis rates detected on HRMRI, DSA and MRA were 0.75 ＋ 0.16, 0.71 ＋ 0.17 and 93.38 ＋ 0.13 respectively. No statistical difference in evaluating the degree of stenosis existed between HRMRI and DSA （Z = -1.43, P = 0.15）, while obvious statistical difference existed between HRMRI and MRA （Z = -2.21, P = 0.027）. Taking DSA as the gold standard, Kappa value of HRMRI in diagnosing MCA stenosis or occlusion was 0.78. Conclusion In evaluating MCA stenosis or occlusion, HRMRI is quite consistent with DSA, and it can avoid the overestimation advantage of MRA. Therefore, it is expected that HRMRI may probably become the gold standard for the diagnosis of cerebral artery stenosis.（J Intervent Radiol, 2014, 23- 96-99）