大脑中动脉高密度征与磁敏感血栓征对大脑中动脉闭塞比较研究

Comparison of middle cerebral artery occlusion between hyperdense middle cerebral artery sign and susceptibility vessel sign

目的比较研究大脑中动脉高密度征(HMCAS)和磁敏感血栓征(SVS)显示大脑中动脉(MCA)闭塞血栓的差异。方法回顾性分析41例临床及影像证实MCA近段闭塞急性脑梗死患者CT及MRI(包含SWI及MRA序列)影像资料。分析HMCAS、SVS显示责任血管血栓灵敏度、特异性、阳性预测值、阴性预测值及其相关性。结果 41例MCA区域急性脑梗死患者中,MRA显示27例同侧MCA近段闭塞,SWI显示21例SVS,CT显示22例HMCAS。HMCAS、SVS显示责任血管血栓灵敏度(78%,78%)、特异性(93%,100%)、阳性预测值(95%,100%)、阴性预测值(68%,70%)。在所有患者中,HMCAS与SVS对预测MCA近段是否闭塞具有高度的一致性(κ值分=0.853);在MRA证实MCA近段闭塞患者中,HMCAS与SVS有无对预测MCA近段是否闭塞具有良好的一致性(κ值分=0.786)。结论 HMCAS、SVS在显示MCA近段血栓具有较好的灵敏度及高度的特异性,并且两者之间具有良好的一致性。

Objective To compare the differences of middle cerebral artery （ MCA） thrombosis between middle cer-ebral artery high density sign （HMCAS） and susceptibility vessel sign （SVS）. Methods CT and MR （ including SWI and MRA sequences） imaging data of 41 cases of acute cerebral infarction for MCA proximal occlusion confirmed by clinical and imaging were retrospectively reviewed. The sensitivity, specificity, positive predictive value, negative predictive value and correlation of HMCAS to SVS were analyzed. Results Of 41 patients with acute cerebral infarction, MRA showed 27 cases with ipsilateral MCA proximal occlusion,21 cases with SVS,22 cases with HMCAS. Respetctively,the sensitivity of HMCAS and SVS was 78% ,78% , specificity： 9 3% , 100% , positive predictive value： 95% , 100% , and negative predictive value： 68% ,70% . The presence or absence of SVS was highly consistent with that of HMCAS when all cases were evaluated （ kap-pa score = 0. 853） , as well as when only patients with MCA proximal occlusion were assessed （ kappa score =0. 786）. Conclusion HMCAS and SVS had a good sensitivity and high specificity in showing proximal thrombus of MCA,and they were highly consistent with each other in acute stroke patients.