BPAS-MRI在椎-基底动脉颅内段夹层鉴别诊断中的应用

The Application of Intracranial Vertebrobasilar Artery Dissection Differential Diagnosis with BPAS-MRI

目的探讨一种新型的磁共振血管成像技术——椎-基底动脉平行解剖磁共振成像(basi-parallel anatomic scanning,BPAS)联合磁共振血管成像(magnetic resonance angiography,MRA)对椎-基底动脉颅内段夹层鉴别诊断的作用。方法参照文献BPAS的扫描条件,由西安交通大学第二附属医院影像科医师及技师探寻适合3.0-MR的扫描及图像处理参数,回顾性分析神经内科部分住院及门诊MRA显示为椎-基底动脉颅内段纤细或不显影、同期进行了BPAS检查的142例患者,其中临床疑诊为动脉夹层者20例,动脉硬化者60例,先天发育不良者62例,由两位未知患者临床资料的影像医师分别对所有患者的MRA及BPAS影像进行阅片,对20例临床疑诊夹层的病例MRA及MRA+BPAS影像诊断结果进行ROC曲线分析,并对两位影像医师的诊断结果进行一致性评估。结果两位影像医师对20例夹层患者MRA+BPAS及MRA阅片诊断结果的ROC曲线下面积分别为0.93vs 0.70和0.96 vs 0.75(P<0.01),提示MRA联合BPAS比单纯MRA的ROC曲线下面积明显增加;MRA联合BPAS诊断椎-基底动脉颅内段夹层的灵敏度比单纯MRA高(100%vs 55%,100%vs 60%,P<0.01);而两种诊断方法的特异度无显著差异(86.89%vs 85.25%,P=0.85;92.62%vs 90.16%,P=0.65);两位影像医师对椎-基底动脉颅内段夹层的诊断结果具有高度的一致性(Kappa=0.85)。结论 BPAS检查可通过显示血管外径与MRA联合精确评估椎-基底动脉颅内段血管状况,区分该部位血管病变为夹层、动脉硬化或先天性发育不良,为该部位血管病变临床治疗方案提供依据。

Objective To explore the effect of combining a new MRI technique named basi-parallel anatomic scanning （BPAS）-magnetic resonance （MR） imaging with time-of-flight （TOF）-MR angiography （MRA） in the diagnosis of differentiating intracranial vertebrobasilar artery dissection （VBD）. Methods Radiologists and radiographer in the Second Affiliated Hospital, School of Medicine, Xi＇an Jiaotong University explored and acquired BPAS scanning parameters suitable for 3.0-MR scanning and image processing according to the screening criteria in the reference of BPAS. A total of 142 patients who underwent BPAS-MR imaging and 3D TOF-MRA in inpatient and outpatient neurology department, including clinical suspected diagnosis of 20 cases of VBD, 60 cases of atherosclerotic narrowing, and 62 cases ofhypoplastic arteries, were retrospectively analyzed. MRA and BPAS images were analyzed by two readers blinded to the patients＇ clinical data. Receiver Operating Characteristic （ROC） curves were performed to compare the capability of conventional MRA with and without BPAS imaging in suspected VBD cases. The consistency of diagnosis results of 2 observers were also evaluated.Results The area under the curve was increased significantly by combining BPAS imaging findings with MRA （0.93 vs 0.70, 0.96 vs 0.75, P〈0.01, respectively by reader No.1 and No.2）. In addition, the sensitivity was 100% for both readers and significantly greater than MRA （55%, 60% for both readers, P〈0.01）. However, specificities were not significantly different （86.89% vs 85.25%, P=0.85; 92.62% vs 90.16%, P=0.65）. The consistency of diagnosis results of 2 observers was excellent （Kappa=0.85）.Conclusion Combining BPAS and MRA can accurately evaluate the intracranial vertebrobasilar condition through revealing the surface appearance of artery, and differentiate VBD from atherosclerosis or hypoplasia, and provide evidence for corresponding treatments.