DSA与高分辨MRI诊断颅外段颈内动脉闭塞性病变的对比研究

Comparative study of DSA and high resolution MRI in diagnosis of extracranial internal carotid artery occlusive disease

目的探讨DSA和高分辨MRI(HR-MRI)在颈内动脉闭塞性病变(ICAO)评估中的临床价值。方法前瞻性纳入单中心符合纳排标准、且经同期DSA和HR-MRI检查,诊断为颈内动脉闭塞的患者。根据Bouthillier法将颈内动脉分为7段,按照Lee诊断标准对所有患者进行DSA诊断,按照Hasan法对所有患者进行闭塞分型。根据Ming-Li的标准对靶血管进行HR-MRI诊断。观察DSA和HR-MRI对ICAO诊断的灵敏度、特异度,比较两种检查方法对闭塞残端形态、闭塞分型、闭塞近端和远端的位置诊断的一致性。结果本研究共纳入47例患者,其中男35例(74.5%),年龄30~79岁,平均(58.6±11.5)岁。33例(70.2%)有临床症状,以偏侧肢体力弱、麻木(53.2%)和言语障碍(21.3%)最常见,少数表现为头晕,视力及视野改变及发作性意识障碍等后循环表现。有症状者mRS评分为(2.0±1.4)分,NIHSS评分为(4.2±4.2)分。DSA诊断为动脉粥样硬化38例,动脉夹层9例。HR-MRI诊断为动脉粥样硬化35例,动脉夹层12例。以HR-MRI为标准,DSA在诊断ICAO病因为动脉粥样硬化的敏感性为97.1%,特异性为66.7%;诊断动脉夹层的敏感性为66.7%,特异性为97.1%;HR-MRI与DSA诊断ICAO病因具有很高的一致性(κ=0.695,P<0.001)。两种影像对判断闭塞起始端、终末端的位置及残端形态也具有很高的一致性(κ=0.846,κ=0.903,κ=0.960;均P<0.001);以HR-MRI为标准,DSA对Hasan分型的不同类型的敏感性差异较大,其中A型和B型可以达到100%,而C型和D型的敏感性分别为77.8%和73.7%,特异性分别为86.8%和92.9%。结论对颅外段动脉粥样硬化和夹层引起的ICAO评估,DSA的敏感性更高,HR-MRI的特异性更高,二者诊断具有较高的一致性,尤其对A型和B型闭塞,但对于C型和D型闭塞,常常需要二者结合判断。

Objective To explore the clinical value of DSA and high resolution MRI(HR-MRI) for internal carotid artery occlusion(ICAO).Methods Prospectively collected patients with internal carotid artery occlusion in a single stroke center that accord with the criteria of inclusion and exclusion, these patients were diagnosed by DSA and HR-MRI at the same times. According to Bouthillier criteria, common carotid arteriography, the internal carotid artery was divided into 7 segments;according to the Lee diagnostic criteria, all patients were diagnosed by DSA, and occlusive classification was performed for all patients by the Hasan method. Target vessels were diagnosed by HR-MRI according to the Ming-Li criteria. The sensitivity and specificity were evaluated in diagnosis of internal carotid artery occlusion by DSA and HR-MRI, and the consistency of the two methods in the diagnosis of occlusive stump morphology, occlusion type, proximal and distal occlusive position was compared. Results A total of 47 patients were included in this study, including 35 males(74.5%). They were during 30-79 years old and the average age was(58.6±11.5) years. Clinical symptoms were showed in 33 cases(70.2%), with weakness, numbness(53.2%) and illegibility in speech(21.3%) being the most common, a few of patients showed dizziness, vision and vision field change and transient unconsciousness and other manifestations occurred in posterior circulation. The mRS score of patients with symptoms was(2.0±1.4), and the NIHSS score was(4.2±4.2). There were 38 cases of atherosclerosis and 9 cases of arterial dissection diagnosed by DSA. Thirty-five cases of atherosclerosis and 12 cases of arterial dissection diagnosed by HR-MRI. With HR-MRI as the criteria,the sensitivity and specificity of DSA in diagnosing ICAO disease were 97. 1% and 66. 7% respectively;the sensitivity and specificity for diagnosing arterial dissection with ICAO were 66. 7% and 97. 1%;the diagnosis of occlusive etiology by DSA have a high coherence with HR-MRI( κ = 0. 695,P < 0. 001). The two imaging methods were also highly consistent in determining the position of the start and terminal of the occlusion,the shape of the stump( κ = 0. 846,κ = 0. 903,κ = 0. 960;all P < 0. 001);with HR-MRI as the criteria,the sensitivity of DSA to different types of Hasan classification was significantly different,in which type A and B could reach 100%,while type C and D were 77. 8% and 73. 7%. But the specificity of type C and D were 86. 8% and 92. 9%. Conclusions For the etiological evaluation of the ICAO caused by atherosclerosis and dissection,the sensitivity of DSA is higher,and the specificity of HR-MRI is higher,and the diagnosis of both methods has a high consistency,especially for type A and type B occlusion,but for type C and D occlusion,it is often necessary to judge both together.