高分辨率MRI在鉴别烟雾病和动脉粥样硬化相关性烟雾综合征中的应用价值

The value of high-resolution MRI in the differential diagnosis of Moyamoya disease and atherosclerosis-related Moyamoya syndrome

目的：探讨高分辨率MRI（HR-MRI）在鉴别诊断烟雾病（MMD）和动脉粥样硬化相关烟雾综合征（A-MMS）中的应用价值。方法前瞻性纳入2014年1月至2015年9月我院收治的17例MMD患者和18例A-MMS患者。记录每位患者一般临床资料及大脑中动脉近端高分辨率MR成像表现，测量血管最大横截面积、血管最小横截面积、管腔最大横截面积、管腔最小横截面积、管壁最大厚度、管壁增厚方式（向心性或偏心性），管壁是否强化，并进行统计学分析。计量资料采用t检验，计数资料采用χ2检验。结果 MMD组大脑中动脉近端管壁最大厚度[（0.94±0.17）mm]显著小于A-MMS组[（1.23±0.42）mm]，组间差异具有统计学意义（t=－2.977, P=0.006）。MMD组管壁无强化15例、轻度强化2例，A-MMS组管壁无强化5例、轻度强化5例、明显强化8例，组间差异有统计学意义（χ2=9.794, P=0.001）。16例MMD患者大脑中动脉近端管壁呈向心性增厚，9例A-MMS患者呈向心性增厚，组间差异具有统计学意义（χ2=6.317, P=0.012）。管壁向心性增厚诊断MMD的敏感度为94.1%（16/17），特异度为50.0%（9/18），准确率为71.4%（25/35）。管壁显著强化诊断A-MMS的敏感度为44.4%（8/18），特异度为100%（17/17），准确率为71.4%（25/35）。将管壁最大厚度1.2 mm作为鉴别诊断MMD和A-MMS的阈值，敏感度为55.6%（10/18），特异度为88.2%（15/17），准确率为71.4%（25/35）。结论 HR-MRI可以用来鉴别诊断烟雾病和动脉粥样硬化相关性烟雾综合征。

Objective To explore the value of high-resolution MRI（HR-MRI） on clinical application in the differential diagnosis between Moyamoya disease（MMD） and atherosclerosis-related Moyamoya syndrome （A-MMS）. Methods Seventeen cases of patients with MMD and 18 cases of patients with A-MMS in our hospital from January 2014 to September 2015 were prospectively enrolled in the study. Record the clinical data and the proximal middle cerebral artery （M1 portion） performance on HR-MRI, the max-vessel area, the min-vessel area, the max-lumen area, the min-lumen area, the wall max-thickness, the styles of M1 portion thickening （eccentric or concentric）, whether the wall was enhanced or not, and analysis the recorded data statistically, t test and χ2 test were used for the statistical analysis. Results The wall max-thickness of MMD group was （0.94 ± 0.17） mm, which was smaller than that in A-MMS group （1.23 ± 0.42） mm, there was statistic significance （t=-2.977, P=0.006）. The cases of M1 portion non-enhancement was 15, slight enhancement 2, strong enhancement 0 in MMD group, and non-enhancement 5, slight enhancement 5, strong enhancement 8 in the A-MMS group, the difference was significant statistically （χ2=9.794, P=0.001）. The cases of M1 portion concentric thickening was 16, 9 cases in the A-MMS group, there was statistic difference between them （χ2=6.317, P=0.012）. Wall concentric thickening diagnose the MMD＆amp;nbsp;with a sensitivity of 94.1% （16/17）, specificity of 50.0% （9/18）, accuracy of 71.4%（25/35）. Wall strong enhancement appear in the A-MMS with a sensitivity of 44.4%（8/18）, specificity of 100%（17/17）, accuracy of 71.4%（25/35）.With a cut-off the maximum wall thickness of 1.2 mm could be used to noninvasively differential diagnose the MMD and A-MMS with a sensitivity of 55.6%（10/18）, specificity of 88.2%（15/17）, accuracy of 71.4%（25/35）. Conclusion HR-MRI is a good tool for the differential diagnosis between MMD and A-MMS.