三维对比增强磁共振血管成像动脉期及双期检查诊断头颈动脉狭窄

Arterial-phase and dual-phase 3Dcontrast enhanced MR angiography in diagnosis of head and carotid artery stenosis

目的评价三维对比增强磁共振血管成像(3D CE-MRA)动脉期及3D CE-MRA双期检查对头颈部动脉狭窄的诊断价值。方法对51例患者行3D CE-MRA双期检查,分析3D CE-MRA动脉期检查及3D CE-MRA双期检查表现,并与DSA相对照,分析两者对头颈部动脉狭窄的诊断效能。结果以DSA为金标准,3D CE-MRA动脉期及3D CEMRA双期诊断头颈部动脉狭窄敏感度、特异度、阳性预测值、阴性预测值、总符合率、阳性似然比、阴性似然比分别为90.81%(168/185)、92.96%(871/937)、71.79%(168/234)、98.09%(871/888)、92.60%(1039/1122)、12.90、0.10和90.81%(168/185)、95.62%(896/937)、80.38%(168/209)、98.14%(896/913)、94.83%(1064/1122)、20.73、0.10。3D CE-MRA动脉期、3D CE-MRA双期检查与DSA诊断结果均具有较高的一致性(Kappa=0.730、0.798)。3D CE-MRA动脉期与3D CE-MRA双期检查的特异度、阳性预测值、总符合率差异有统计学意义(P均<0.05)。结论 3D CE-MRA动脉期及3D CE-MRA双期检查与DSA诊断头颈部动脉狭窄具有较高的一致性;且3D CE-MRA双期较3D CE-MRA动脉期检查诊断准确率更高,尤其对诊断重度以上狭窄更具优势。

Objective To evaluate the diagnostic value of arterial-phase and dual-phase 3D contrast enhanced MR angiography（3D CE-MRA） in head and carotid artery stenosis.Methods A total of 51 patients were underwent dual-phase 3D CE-MRA.The images of arterial-phase and dual-phase 3D CE-MRA were observed,and the diagnostic results were compared with that of DSA.Diganostic efficacy of diagnosing head and carotid artery stenosis were analyzed.Results Compared with the results of DSA,the sensitivity,specificity,positive predictive values,negative predictive values,total corresponding rate,positive likelihood ratio and the negative likelihood ratio of arterial-phase and dual-phase 3D CE-MRA in head and carotid artery stenosis were 90.81%（168/185） and 90.81%（168/185）,92.96%（871/937） and 95.62%（896/937）,71.79%（168/234） and 80.38%（168/209）,98.09%（871/888） and 98.14%（896/913）,92.60%（1039/1122）and 94.83%（1064/1122）,12.90 and 20.73,0.10 and 0.10,respectively.There was a high correspondence between the diagnostic results of arterial-phase 3D CE-MRA,dual-phase 3D CE-MRA and DSA（Kappa = 0.730,0.798）.The differences of specificity,positive predictive values and the total corresponding rate between arterial-phase 3D CE-MRA and dualphase 3D CE-MRA were statistically significant（all P〈0.05）.Conclusion Both arterial-phase 3D CE-MRA and dualphase 3D CE-MRA have high correspondence with DSA when diagnosing head and carotid artery stenosis,and dual-phase3 D CE-MRA is more accurate than arterial-phase 3D CE-MRA,even higher accuracy for the patients with serve stenosis.