3.0T MRA在支架辅助弹簧圈栓塞颅内动脉瘤术后随访中的应用研究

Application of 3. 0T MRA in the Follow-up of Endovascular Embolization for the Intracranial Aneurysm

目的评价3.0T磁共振血管成像(MRA)技术在颅内动脉瘤支架辅助弹簧圈栓塞术后随访中的应用。方法对32例在笔者医院行颅内动脉瘤支架辅助弹簧圈栓塞术后1~2年的患者进行影像学随访,行3.0T MRA(包括TOF-MRA和CE-MRA)及数字减影血管造影(DSA)检查。以DSA结果为金标准,对MRA的影像质量及结果进行比较分析。结果 3.0T TOF-MRA判断支架辅助弹簧圈栓塞术后动脉瘤复发的敏感度为50%,特异性为100%,总准确率为37.5%,与DSA比较,差异有统计学意义(P<0.01);对判断载瘤动脉通畅性的准确率为37.5%,与DSA比较,差异有统计学意义(P<0.01)。3.0T CEMRA对判断动脉瘤复发的敏感度均为50%,特异性均为100%,总准确率为71.9%,与DSA比较,差异无统计学意义(P>0.05);对判断载瘤动脉通畅性的准确率分别为62.5%,与DSA比较差异有统计学意义(P<0.05)。3.0T TOF-MRA与CEMRA两组间对评估动脉瘤栓塞术后情况的准确率,差异有统计学意义(P<0.01)。结论 3.0T TOF-MRA在评估支架辅助弹簧圈栓塞颅内动脉瘤术后患者的准确率低;3.0T CE-MRA优于TOF-MRA,与DSA相当,可作为随访的首选手段。3.0T TOFMRA及CE-MRA对评估载瘤动脉通畅性的准确率均较低,通过优化序列参数的方法可能获得更佳的图像。对于MRA阳性及不确定性结果应个体化分析,必要时行DSA检查。

Objective To evaluate the application of 3.0T Magnetic resonance angiography （MRA） in follow -up the intracranial aneurysm which embolize by stent - assisted coil retrospectively. Methods In our hospital,32 patients who underwent intracranial aneu- rysm embolization by stent - assisted coil were followed up for one to two year with radiologic examination. All patients were followed up with 3.0T MRA （TOF- MRA ＋ CE- MRA） and Digital subtraction angiography（DSA）examination. DSA served as the golden stand- ard. The MRA image quality and the results were compared. Results The 3.0T TOF - MRA to determine the sensitivity of aneurysm re- currence was 50% , specificity were 100% , accuracy was 37.5% , there was significant difference compared with DSA （P 〈0.01 ）. The accuracy of the patency of the parent artery was 37.5% , there was significant difference compared with DSA （P 〈 0.01 ）. The 3.0T CE - MRA to determine the sensitivity of aneurysm recurrence was 50% , specificity were 100% , accuracy were 71.9% , there was no signifi- cant difference compared with DSA （ P 〉 0.05 ）. The accuracy of the patency of the parent artery was 62.5% , there was significant differ- ence compared with DSA （ P 〈 O. 05 ）. Between the groups of 3. OT TOF - MRA and CE - MRA, there was significantly different to evalua- ting the accuracy of the aneurysm after embolized （P 〈 0.01 ）. Conclusion 3.0T TOF - MRA in the evaluation of stent assisted coil em- bolization of intraeranial aneurysms with low accuracy. 3.0T CE - MRA was superior to TOF - MRA, and equivalent to DSA. We can use 3.0T CE - MRA as the first choice for follow - up. The accuracy of 3.0T TOF - MRA and CE - MRA to evaluate the pateney of the parent artery were low, by optimizing the sequence parameters may obtain a better image. For MRA positive and uncertainty of results should be analyzed individually, if necessary, perform DSA.