3D-SPACE MRI对后循环颅内段不同支架的随访评价

Application of 3D-SPACE MRI in evaluating in-stent restenosis degree after implantation of different stents in posterior circulation intracranial segment

目的初步探讨三维可变翻转角快速自旋回波序列(3D-SPACE)MRI对后循环颅内段支架植入术后支架内再狭窄(ISR)程度的随访价值。方法回顾性分析2017年4月至2018年10月郑州大学第一附属医院收治的20例后循环颅内段Neuroform、Enterprise、Solitaire等3种支架植入术后接受DSA和3D-SPACE MRI随访患者临床资料。评价不同支架3D-SPACE MRI所示ISR程度图像质量,并与DSA检查结果作对比,进而展示其随访价值。结果20例患者中植入Neuroform支架16例、Enterprise支架3例、Solitaire支架1例,DSA证实ISR 8例(Neuroform支架5例,Enterprise支架2例,Solitaire支架1例)。3D-SPACE MRI图像质量分析显示,Solitaire支架近端可见明显磁敏感伪影,Neuroform和Enterprise支架成像质量良好。3D-SPACE MRI所检测Neuroform支架ISR狭窄程度与DSA一致性较高。8例ISR患者图像分析显示,2例Neuroform支架3D-SPACE MRI强化范围大于DSA,6例强化范围与DSA一致;5例Neuroform支架中3例3D-SPACE MRI表现为弥漫性强化。结论3D-SPACE MRI可用于后循环颅内段Neuroform、Enterprise支架植入术后随访。其管壁强化规律及临床指导价值尚需进一步研究,Solitaire支架评估还需更大样本量研究。

Objective To preliminarily discuss the value of three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions(3D-SPACE)MRI sequence in the follow-up observation of in-stent restenosis(ISR)degree after implantation of different stents in posterior circulation intracranial segment.Methods The clinical follow-up DSA and 3D-SPACE MRI materials of 20 patients,who received stent implantation in posterior circulation intracranial segment with three different stents(including Neuroform,Enterprise and Solitaire)during the period from April 2017 to October 2018 at the First Affiliated Hospital of Zhengzhou University of China,were retrospectively analyzed.The qualities of 3DSPACE MRI images that well displayed the ISR degree of different stents were evaluated,and the results were compared with DSA findings so as to clarify the follow-up value of 3D-SPACE MRI.Results Among the 20 patients,Neuroform stent was used in 16,Enterprise stent was employed in 3,and Solitaire stent was adopted in one.DSA confirmed that ISR occurred in 8 patients.Of the 8 patients,Neuroform stent was used in 5,Enterprise stent in 2 and Solitaire stent in one.The analysis of the quality of 3D-SPACE MRI imaging quality showed that obvious magnetic sensitive artifacts were demonstrated at the proximal end of Solitaire stent,and both Neuroform stent and Enterprise stent were displayed with excellent imaging quality.The stenotic degree of Neuroform stent measured by 3D-SPACE MRI was highly consistent with DSA results.Image analysis of 8 patients with ISR demonstrated that the enhancement extent of Neuroform stent on 3DSPACE MRI was greater than that on DSA in 2 patients and was quite consistent with that of DSA in 6 patients.Of 5 patients using Neuroform stent,diffuse enhancement on 3D-SPACE MRI was observed in 3 patients.Conclusion 3D-SPACE MRI can be used in follow-up observation after the implantation of Neuroform stent and Enterprise stent in posterior circulation intracranial segment.The regular pattern of stent wall enhancement and its clinical guidance value need to be further studied,and the evaluation of Solitaire stent requires more studies with large sample.