高分辨率血管壁MRI定量参数鉴别诊断烟雾病及动脉粥样硬化的价值分析

Value of High Resolution MRI of Vascular Wall Quantitative Parameter in Differentiating Moyamoya Disease and Atherosclerosis

目的:探究高分辨率血管壁磁共振成像(HR-MRI)定量参数鉴别烟雾病(MMD)及动脉粥样硬化(AS)的临床价值。方法:回顾性分析厦门大学附属中山医院2019年10月-2021年10月收治的31例MMD患者(MMD组)及54例AS患者(AS组)临床资料,两组均接受HR-MRI检查,分别比较两组大脑中动脉定量参数(狭窄段血管壁外径、外缘面积)差异,并分析两组狭窄类型、管壁信号强度等特征。采用ROC曲线分析血管壁外径、外缘面积对MMD及AS的鉴别价值。结果:MMD组狭窄段血管壁外径及血管外缘面积均明显小于AS组,差异有统计学意义(P<0.05);MMD组大脑中动脉狭窄程度明显较AS组更严重,且其大脑中动脉向心性狭窄及管壁信号均匀情况均明显高于AS组,差异有统计学意义(P<0.05)。大脑中动脉狭窄段血管壁外径及外缘面积鉴别MMD的AUC分别为0.870、0.962,截断值分别为2.82 mm、3.30 mm^(2)。结论:与AS相比,HR-MRI显示MMD患者在狭窄段血管壁外径更小,呈向心性狭窄,管壁信号更均匀,其狭窄段血管壁外径、外缘面积两项定量参数在MMD与AS的鉴别和诊断中具有良好的应用价值。

Objective:To explore the clinical value of high-resolution magnetic resonance imaging of vascular wall(HR-MRI)quantitative parameter in differentiating moyamoya disease(MMD)from atherosclerosis(AS).Method:Clinical data of 31 patients with MMD(MMD group)and 54 patients with AS(AS group)admitted to Zhongshan Hospital,Xiamen University from October 2019 to October 2021 were retrospectively analyzed.Patients in both groups received HR-MRI examination.The quantitative parameters of middle cerebral artery(diameter of vessel wall and area of outer margin in stenotic segment)were compared between the two groups,the characteristics of stenosis type and wall signal intensity were analyzed.ROC curve was used to analyze the identification value of outer diameter of vessel wall and area of outer edge for MMD and AS.Result:The vascular wall diameter and vascular margin area in stenotic segment in MMD group were significantly smaller than those in AS group,the differences were statistically significant(P<0.05).The degree of middle cerebral artery stenosis in MMD group was significantly worse than that in AS group,and the centripetal stenosis and the uniformity of wall signal of the middle cerebral artery were significantly higher than those in AS group,with statistical significances(P<0.05).The AUC of outer diameter of vessel wall and area of outer edge in stenotic segment for identifying MMD were 0.870 and 0.962,and the cut-off value were 2.82 mm and 3.30 mm^(2),respectively.Conclusion:Compared with AS,HR-MRI shows that MMD patients had smaller outer diameter of vessel wall in stenotic segment,centralizing stenosis and more uniform wall signal,which has good application value of the two quantitative parameters of vessel wall diameter and outer edge area of stenosis segment in the differentiation and diagnosis of MMD and AS.