静音MR血管成像在颅内动脉瘤弹簧圈介入栓塞术后随访中的作用

The application of Silenz MR angiography in the follow-up assessment of intracranial aneurysms embolization

目的：探讨静音MRA在颅内动脉瘤弹簧圈介入栓塞术后随访中的应用价值。方法前瞻性收集行单纯弹簧圈介入栓塞术治疗的窄颈颅内动脉瘤患者15例，术后行DSA检查，并于DSA检查前当日行MRA检查。MRA图像采集分别采用静音MRA和时间飞跃法MRA（TOF MRA）。对栓塞动脉瘤周围血管结构采用4分法进行评估，并评价栓塞状态（分为完全栓塞或不完全栓塞）。采用Wilcoxon秩和检验比较静音MRA和TOF MRA间瘤周血管结构评分的差异。采用一致性（Kappa）检验评估静音MRA与TOF MRA间、静音MRA与DSA间、TOF MRA与DSA间所显示栓塞状态的一致性。结果 DSA显示完全栓塞11例，不完全栓塞4例。静音MRA和TOF MRA显示瘤周血管结构的评分分别为（3.50±0.62）、（3.00±0.63）分，差异有统计学意义（Z=－3.12，P=0.002）。15例静音MRA与DSA结果一致，具有高度一致性，Kappa值为0.82；13例TOF MRA与DSA结果一致，具有中度一致性， Kappa值为0.60；13例静音MRA与TOF MRA结果一致，具有高度一致性，Kappa值为0.76。静音MRA图像上显示残留瘤颈、瘤体清晰，TOF MRA图像上无法完整显示残留瘤颈。结论静音MRA显示颅内动脉瘤弹簧圈介入栓塞术后瘤周血管结构以及栓塞状态优于TOF MRA，与DSA结果一致。

Objectives To explore the value of Silenz MRA in the follow-up assessment of intracranial aneurysms embolization. Methods Fifteen patients underwent coiled embolization were prospectively collected. Silenz and time of flight MRA （TOF MRA） were performed on the same day as DSA examination. Two neuro-radiologists scored the structures of peripheral vascular with a 4-score grading system and evaluate embolism status （two-grade montreal scale）. The scores of vascular structures were compared using Wilcoxon signed rank tests. Weighted Kappa statistics was used to assess the inter-observer agreement on each MRA scoring, the inter-modality agreement between MRA and DSA, the inter-modality agreement between the MRA methods. Results There were 11 cases with complete occlusion, 4 cases with residual aneurysm revealed by DSA. For depiction, Silenz MRA was significantly better than TOF MRA [（3.50 ± 0.62） vs. （3.00 ± 0.63）, Z=-3.12, P=0.002]. Inter-modality agreement of Silenz MRA and DSA was excellent （Kappa=0.82）, while the agreement of TOF MRA and DSA was moderate（Kappa=0.60）. Inter-modality agreement between Silenz MRA and TOF MRA was good （Kappa=0.76）. Conclusions Silenz MRA is superior to TOF MRA for depiction of vascular structures and evaluation of embolism status, which is highly related with DSA. It has the value in the postoperative follow-up evaluation.