3D-TOF-MRA对破裂、未破裂脑动脉瘤检出效能的对照研究

3D-TOF MRA at 3.0T for the Diagnosis of Intracranial Aneurysms in Patients with or without Subarachnoid Hemorrhage

目的:探讨3.0T 3D-TOF-MRA对破裂、未破裂脑动脉瘤检出效能。方法:自2007年6月至2012年2月,183例经头颅CT平扫确诊蛛网膜下腔出血患者,和228例疑似患有脑动脉瘤或其他脑血管疾病无蛛网膜下腔出血的患者,分别行3.0T 3D-TOF-MRA检查和DSA检查,DSA作为诊断的金标准,检测以患者、动脉瘤、动脉瘤大小为基础的动脉瘤检出的准确性、敏感性、特异性、阳性预测值、阴性预测值。结果:蛛网膜下腔出血组151例患者,共计185枚脑动脉瘤,32例患者无动脉瘤;非蛛网膜下腔出血组193例患者,共计234枚脑动脉瘤,35例患者无动脉瘤。蛛网膜下腔出血组4枚动脉瘤假阴性,2枚假阳性。非蛛网膜下腔出血组6枚假阳性。除了基于患者、动脉瘤为基础评价动脉瘤的敏感性有统计学差异外(P=0.037),基于患者、动脉瘤、动脉瘤大小为基础的准确性、敏感性、特异性、阳性预测值、阴性预测者均无统计学差异。结论:3.0T 3D-TOF-MRA对破裂动脉瘤、非破裂脑动脉瘤检出均具有良好的敏感性和准确性。

Purpose： To determine the diagnostic accuracy of 3D-TOF MRA at 3.0T.MRI machine for detection of intracranial aneurysms in patient with subarachnoid hemorrhage（SAH） or without SAH. Methods： One hundred and eighty-three patients with SAH and 228 patients without SAH underwent 3D-TOF MRA for the detection of intracranial aneurysms. DSA were regarded as the golden standard. The accuracy, sensitivity, specificity, positive predictive values（PPV）, and negative predictive values（NPV） were determined by patient-, aneurysm-, and aneurysm size-based evaluations. Results： According to the reference standard, 185 aneurysms were detected in 151 patients with SAH, and 234 aneurysms were detected in 193 patients without SAH. Four false-negative aneurysms and two false-positive aneurysms were detected in SAH group, and six false-positives were found in non-SAH group. Except for a slight difference in sensitivity in patient-based and aneurysm-based evaluation（P=0.037）, there were no other significant differences in accuracy, sensitivity, specificity, PPV, and NPV in patient-based, aneurysm-based and aneurysm size-based evaluation. Conclusions： These results indicated that 3D-TOF MRA is an effective approach in diagnosis of intracranial aneurysm in patients with or without SAH.