3D-VISTA在自发性头颈动脉夹层中的诊断价值

The Diagnostic Value of 3D Volumetric Isotropic TSE Acquisition in Spontaneous Cervicocerebral Artery Dissection

目的分析自发性头颈动脉夹层(SCAD)在三维容积各向同性快速自旋回波(3D-VISTA)高分辨率磁共振成像(HRMRI)中的影像学特征,并探讨3D-VISTA HRMRI在SCAD的应用价值。方法搜集头颈部血管同时行DSA及3D-VISTA扫描的51例患者(65支血管),以DSA为诊断金标准,计算3D-VISTA诊断SCAD的敏感性、特异性等指标。结果 DSA及3D-VISTA分别诊断夹层17例(19支血管)和19例(24支)。3D-VISTA诊断夹层敏感性为84.2%,特异性为82.6%,阳性预测值为66.7%,阴性预测值为92.7%。壁间血肿(14支)、内膜片(13支)、双腔征(8支)、动脉瘤样扩张(6支)、壁间血肿或假腔沿真腔呈螺旋状走行(9支)为SCAD在3D-VISTA中的特征性影像征象。结论 3D-VISTA能同时显示管腔及管壁信息,对壁间血肿敏感性高,对于其他影像学检查无法确诊的夹层病例,可行病变段血管3D-VISTA扫描,提高诊断正确率。

Objective To investigate the imaging features of 3D Volumetric Isotropic TSE Acquisition and their diagnostic value in Spontaneous cervicocerebral artery dissection（SCAD）.Methods Collection of the clinical and imaging data of patients who underwent both 3D-VISTA and DSA examinations.Referring DSA as the gold standard,the sensitivity,specificity and other indicators of SCAD were calculated by 3D-VISTA.Results There were 51 cases and 65 blood vessels in total.17 cases（19 blood vessels）,19 cases（24 blood vessels） were confirmed by DSA and 3D-VISTA respectively.The sensitivity of the 3D-VISTA for SCAD was 84.2%,the specificity was 82.6%,the positive predictive value was66.7% and the negative predictive value was 92.7%.Intramural hematoma,intimal flap,double lumen sign,aneurysmal dilatation,intramural hematoma or false lumen along true lumen spiral out of shape were observed in 14,13,8,6 and 9blood vessels,respectively,and these demonstrations were the characteristic imaging findings of dissection in 3D-VISTA.Conclusion 3D-VISTA can display the lumen and wall information at the same time,and it is highly sensitive to intramural hematoma.For the cases which cannot be diagnosed by other imaging methods,the designed scan of vascular lesion segment by 3D-VISTA is recommended; it can reliably improve the diagnostic accuracy of SCAD.