深部微小流空在血管壁MRI鉴别诊断动脉粥样硬化和急性动脉炎中的增益价值

DTFV Value-Added in the Identify of Atherosclerosis Stenosis Disease and Acute Arteritis by Vessel Wall MRI

目的探讨深部微小流空(DTFV)现象在血管壁磁共振成像(VW-MRI)鉴别诊断动脉粥样硬化和急性动脉炎中的增益价值。方法回顾性分析大脑中动脉症状性狭窄且接受治疗的183例患者的VW-MRI资料,分别以VW-MRI和VW-MRI联合DTFV两种方法判断大脑中动脉动脉粥样硬化性狭窄(ICAD)或急性动脉炎性狭窄,判断结果分别与临床确诊结果相比较,并进行统计学检验,以影像学资料、生化实验室检查及随访结果等综合信息为确诊依据,最终诊断为动脉粥样硬化159例和急性动脉炎24例。结果ICAD组DTFV发生率显著大于急性动脉炎组[74.2%(118/159)vs.0%(0/24),χ^(2)=50.146,P=0.000]。VW-MRI诊断动脉粥样硬化的灵敏度84.3%(134/159),特异度100%(24/24),准确率86.3%(158/183),与最终确诊一致率Kappa值=0.584,其中磁共振表现包括斑块形态、血管壁强化方式。VW-MRI联合DTFV诊断动脉粥样硬化的灵敏度95%(151/159),特异度100%(24/24),准确率95.6%(175/183),与最终确诊一致率Kappa值=0.832。VW-MRI联合DTFV诊断动脉粥样硬化的准确率高于VW-MRI,差异具有统计学意义(χ^(2)=16.50,P=0.002)。VW-MRI,VW-MRI联合DTFV诊断ICAD的受试者工作特征曲线(ROC)曲线下面积(AUC)及95%置值区间(CI)分别是0.921(0.883~0.960),0.975(0.954~0.996),差异具有统计学意义(P<0.001)。结论DTFV在VW-MRI对动脉粥样硬化和急性动脉炎的鉴别诊断中具有较高的增益价值,能提高大脑中动脉ICAD的诊断准确率。

Objective To explore the value-added by deep tiny flow voids(DTFV)phenomena in the identify of atherosclerosis stenosis disease(ICAD)and acute arteritis by vessel wall magnetic resonance imaging(VW-MRI).Methods Retrospectively analysis 183 patients’VW-MRI data with middle cerebral artery symptomatic stenosis who received treatment,applying VW-MRI appearance and VW-MRI appearance combined with DTFV phenomenon the two methods respectively to indentify middle cerebral artery stenosis,which compared with the clinical diagnosis criterion,and to do statistical tests.Clinical diagnosis evidence was imaging,biochemical laboratory examination and follow up result,159 patients were ICAD,24 were acute arteritis.Results The proportion of DTFV phenomena in the ICAD group was statistically higher than that in the acute arteritis group,74.2%(118/159)vs.0%(0/24),χ^(2)=50.146,P=0.000.VW-MRI appearance diagnosed ICAD with a sensitivity of 84.3%(134/159),specificity of 100%(24/24),accuracy of 86.3%(158/183),accordance ratio K=0.584,VW-MRI appearance include morphological characteristics of plaque and enhancement pattern.VW-MRI combined with DTFV phenomena diagnosed ICAD with a sensitivity of 95%(151/159),specificity of 100%(24/24),accuracy of 95.6%(175/183),accordance ratio K=0.584.The accuracy of VW-MRI combined with DTFV phenomena for indentifying ICAD was statistically higher than that of VW-MRI,χ^(2)=16.50,P=0.002.Areas under the ROC curve(AUC)and 95%confidence interval(CI)were 0.921(0.883-0.960)for VW-MRI,0.975(0.954-0.996)for VW-MRI combined with DTFV phenomena.The area under the ROC was statistically different between VW-MRI and VW-MRI combined with DTFV phenomena(P=0.000).Conclusion VW-MRI combined with DTFV phenomena may improve the diagnostic accuracy of middle cerebral artery ICAD,provide more information than VW-MRI in different diagnosis of ICAD and acute arteritis.