三维可变反转角快速自旋回波序列在颅内动脉支架术后随访中的价值

Application of three dimensional sampling perfection with application optimized contrasts using different flip angle evolutions in the follow-up of intracranial artery stenting

目的探讨三维可变反转角快速自旋回波(3D-SPACE)序列,在颅内动脉支架植入术后随访中的临床价值。方法研究为回顾性临床资料分析。搜集2017年4月至2018年4月郑州大学第一附属医院神经介入科,颅内动脉粥样硬化性狭窄支架植入术后19例患者的临床及影像资料。患者随访时,在DSA后3 d内行3D-SPACE序列MR检查。由2名医师分别对DSA和MRI图像进行双盲读片,参照华法林-阿司匹林试验研究方法测量支架内管腔狭窄程度。采用组内相关系数(ICC)评价2名医师之间对DSA及3D-SPACE序列测量结果的一致性。以DSA为金标准,根据检测结果狭窄程度分为≥50%和<50%,评估3D-SPACE序列测量结果的敏感度、特异度、阳性预测值、阴性预测值。采用配对样本t检验比较3D-SPACE序列与DSA所测狭窄程度的差异。结果2名医师测量结果一致性评价较好,DSA的ICC值为0.903(P<0.01)、3D-SPACE序列的ICC值为0.875(P<0.01)。以DSA为金标准,3D-SPACE序列诊断支架内狭窄程度的敏感度、特异度、阳性预测值、阴性预测值分别为100.0%、80.0%、81.8%、100.0%。所测支架内平均狭窄程度,DSA为(51.7±19.2)%,3D-SPACE序列为(55.5±18.9)%,差异无统计学意义(t=1.675,P=0.111)。结论3D-SPACE序列可作为一种无创成像方法用于颅内动脉支架植入术后患者的随访。

Objective To explore the value of three dimensional sampling perfection with application optimized contrasts using different flip angle evolutions(3D-SPACE)magnetic resonance for postoperative follow-up of intracranial artery stent.Methods The clinical and imaging data of 19 patients with intracranial atherosclerotic stenosis after stent implantation were collected retrospectively from April 2017 to April 2018 in the Department of Neurology,First Affiliated Hospital of Zhengzhou University.3D-SPACE sequence magnetic resonance examination was performed within 3 days after digital substraction angiography(DSA).Double-blind readings of DSA and MRI images were performed by two physicians,and the degree of lumen stenosis in the stent was measured by the WASID study method.The intra-group correlation coefficient was used to evaluate the consistency of the DSA and 3D-SPACE sequence measurements between the two physicians.The sensitivity,specificity,positive predictive value,and negative predictive value of 3D-SPACE sequence measurement results were evaluated using DSA as the gold standard.Paired sample t test was used to compare the difference in the degree of stenosis between the 3D-SPACE sequence and the DSA.Results Good inter-observer agreement was noted between the two physicians.The ICC value of DSA was 0.903(P<0.01),and the ICC value of the 3D-SPACE sequence was 0.875(P<0.01).With DSA as the gold standard,the sensitivity,specificity,positive predictive value and negative predictive value of the 3D-SPACE sequence in the diagnosis of stent stenosis were 100.0%,80.0%,81.8%,and 100.0%,respectively.The average stenosis degree in the stent measured by DSA was(51.7±19.2)%,and the 3D-SPACE sequence was(55.5±18.9)%.The difference was not statistically significant(t=1.675,P=0.111).Conclusions 3D-SPACE sequence magnetic resonance imaging can be used as a non-invasive imaging method for follow-up after intracranial stenting.