高分辨率磁共振管壁成像对头颈动脉夹层的诊断价值评价

Value of high resolution magnetic resonance vessel wall image in evaluating cervicocerebral artery dissection

目的探讨高分辨率磁共振管壁成像技术(HRMR-VWI)对头颈动脉夹层(CAD)的诊断价值。方法回顾性连续纳入2017年1月至2019年10月因缺血性卒中症状就诊于云南省第一人民医院神经内科的临床疑诊CAD患者52例,均行HRMR-VWI检查。病变的内膜瓣征和(或)双腔征和(或)壁内血肿等影像学征象作为临床和HRMR-VWI诊断的主要依据,其中临床诊断是对病史、实验室资料及所有影像学检查(CT血管成像、MR血管成像、DSA及超声)进行综合判断。由2名经验丰富的高年资影像科医师对HRMR-VWI结果进行盲法分析,对两位医师的影像学判读结果进行可靠性评价;以最终的临床诊断作为标准,将HRMR-VWI诊断结果与临床诊断进行比较,对HRMR-VWI诊断CAD的敏感度和特异度进行评价。Kappa值≥0.75为一致性较好,Kappa值<0.4为一致性较差。结果(1)52例临床疑诊CAD患者中,临床最终确诊CAD患者31例,无CAD者21例。(2)2名医师对双腔征、内膜瓣征、壁内血肿、管壁强化、管腔改变等影像学表现判别结果的一致性均较好,符合率分别为90.4%(47/52)、92.3%(48/52)、94.2%(49/52)、92.3%(48/52)、92.3%(48/52),Kappa值分别为0.804、0.844、0.885、0.838及0.840(均P<0.01)。(3)HRMR-VWI与临床最终诊断对双腔征、内膜瓣征、壁内血肿诊断的一致性均较好,符合率分别为98.1%(51/52)、96.2%(50/52)、96.2%(50/52),Kappa值分别为0.961、0.922、0.923(均P<0.01)。(4)HRMR-VWI诊断夹层的敏感度为96.8%,特异度为90.5%,阳性预测值为93.8%,阴性预测值为95.0%(均P<0.01)。结论HRMR-VWI对CAD的诊断具有良好的效能。

Objective To discuss the diagnostic value of high-resolution magnetic resonance vessel wall image(HRMR-VWI)in the cervicocerebral artery dissection(CAD).Methods From January 2017 to October 2019,a total of 52 suspected CAD patients who were admitted to the Department of Neurology,the First people′s Hospital of Yunnan Province due to ischemic stroke symptoms were analyzed retrospectively.All of them underwent HRMR-VWI.Imaging features such as intimal flap,double lumen and intramural hematoma are the main basis for clinical diagnosis.The clinical diagnosis is a comprehensive judgment of medical history,laboratory data and all imaging examinations(CT angiography,MR angiography,DSA and ultrasound).The HRMR-VWI imaging features of CAD were double-blind analyzed by two experienced senior radiologists.The reliability of imaging interpretation results of the two radiologists was evaluated.The final clinical diagnosis was used as the reference standard to evaluate the authenticity and reliability of HRMR-VWI diagnosis in CAD.Kappa value≥0.75 indicates good consistency,and Kappa value<0.4 indicates poor consistency.Results(1)Among the 52 patients suspected to have CAD,31 were confirmed to have CAD and 21 were not.(2)The consistency analysis about the imaging features of double lumen,intimal flap,intramural hematoma,vessel wall enhancement and lumen changes by two radiologists showed good results.The coincidence rates were 90.4%(47/52),92.3%(48/52),94.2%(49/52),92.3%(48/52),92.3%(48/52),respectively.Kappa values were 0.804,0.844,0.885,0.838 and 0.840,respectively.The P values were all<0.01.(3)The consistency analysis about the imaging features of double lumen,intimal flap and intramural hematoma by HRMR-VWI and the final clinical diagnosis suggested that all Kappa values were good.The coincidence rates were 98.1%(51/52),96.2%(50/52)and 96.2%(50/52),respectively.Kappa values were 0.961,0.922 and 0.923,respectively.The P values were all<0.01.(4)The sensitivity,specificity,positive predictive value and negative predictive value of HRMR-VWI were 96.8%,90.5%,93.8%and 95.0%,respectively.The P values were all<0.01.Conclusion HRMR-VWI has good performance in CAD diagnosis.