Time-SLIP、CE-MRA、DSA在颈动脉斑块管腔狭窄检查的对照研究

Comparison of Time-SLIP, CE-MRA and DSA in Estimation of Carotid Plaque Stenosis

目的:评估Time-SLIP血管成像的成像质量,评价Time-SLIP、CE-MRA以及DSA在颈动脉狭窄度评估方面的差异。方法:(1)35例具有颈动脉斑块的患者先后使用磁共振进行Time-SLIP和CE-MRA扫描,其中10例患者三天后进一步行颈动脉DSA检查。(2)在获取Time-SLIP和CE-MRA颈动脉血管图像后分别由两位副高级影像诊断医师对每幅图像质量、组织污染情况进行技术评分。(3)对Time-SLIP、CEMRA显示的血管数量进行评价。(4)对其中进行过DSA检查的10例患者,以NASCET法计算上述三种方法显示的颈动脉血管狭窄率。结果:(1)35例患者,Time-SLIP组和CE-MRA组中,图像质量为3分以上者分别占94.2%、97.1%;组织污染评分小于等于1分者分别占88.6%、82.9%;双侧颈动脉总共210条血管,Time-SLIP和CE-MRA分别显示两侧颈总动脉、颈内动脉及颈外动脉血管为199/210条和202/210条,其符合率分别为94.8%和96.2%。上述诊断两位医师的一致性较高,Kappa值>0.80,两种方法的差异无统计学意义(P>0.05)。(2)其中接受DSA检查的10例患者,以DSA诊断为金标准,在颈动脉狭窄的诊断中Time-SLIP诊断的敏感性92.31%,特异性97.87%,准确性96.67%,Kappa=0.90;CE-MRA诊断的敏感性100%,特异性97.87%,准确率98.33%,Kappa=0.95。结论:(1)Time-SLIP是一种无创MRA成像技术,成像质量较好。(2)Time-SLIP可以用于颈动脉狭窄评估。(3)由于Time-SLIP技术能有效提示管腔狭窄程度,因此其有较高的临床应用价值。

Purpose： To evaluate the imaging quality of Time-SLIP angiography and evaluate the differences between Time-SLIP, CE-MRA, and DSA in the assessment of carotid artery stenosis. Methods： Thirty-five patients with carotid plaques were scaned with magnetic resonance with Time-SLIP and CE-MRA sequences, 10 of them were also undergone with carotid DSA. After the carotid artery images of the Time-SLIP and the CE-MRA were obtained, the image quality and the pollution situation of each group were evaluated by two senior doctors respectively. The number of vessels displayed by Time-SLIP, CE-MRA was evaluated. Stenosis ratio of 10 cases of carotid artery was calculated by NASCET method. Results： The cases with image quality more than 3 points were accounted for 94.2% and 97.1% of Time-SLIP group and CE-MRA group, respectively; and the cases with tissue pollution score of less than or equal to 1, were accounted for 88.6%, 82.9%, respectively. There were 210 vessels on both sides. Time-SLIP and CE-MRA showed 199/210 and 202/210 arteries on both sides of the carotid arteries, internal carotid artery and external carotid arteries, respectively. The coincidence rates were 94.8% and 96.2%. And the consistency of the two diagnostic doctors was higher, the Kappa values were more than 0.80, the difference between the two methods was not with statistical significant （P〉 0.05）. Ten patients was diagnosed by DSA which was used as golden standard. For the Time-SLIP, the sensitivity was 92.31%, the specificity was 97.87%, the accuracy was 96.67%, Kappa = 0.90; and for the CE-MRA, the sensitivity was100%, the specificity was97.87%, the accuracy was 98.33%, Kappa = 0.95. Conclusion： Time-SLIP is a kind of non-invasive MRA imaging technique without using contrast agent, and the imaging quality is excellent, which is suitable for primary examination. Time-SLIP can be used effectively for diagnosis of carotid artery stenosis. Because the Time-SLIP technique does not rely on the contrast agent injection to display the degree of luminal stenosis, so it has a higher clinical application prospects.