无创诊断对儿童颅内动静脉畸形隐匿性病变及时精准诊断分析与评估

Non-invasive diagnosis for timely and accurate diagnostic analysis and evaluation of occult intracranial arteriovenous malformations in children

目的探究无创诊断对儿童颅内动静脉畸形(AVM)隐匿性病变的及时精准诊断及评估价值.方法选取2017年1月至2018年12月河北省儿童医院65例疑似AVM患儿为观察组,均行MRI及3D-TOF-MT-MRA检查,比较两种检查方法图像质量、信噪比(SNR)、对比度噪声比(CNR),以数字减影血管造影(DSA)检查结果为"金标准",比较MRI、3D-TOF-MT-MRA单独及联合诊断儿童AVM的价值及评估Spetzler-Martin分级的准确性,另选取本院收治的65例AVM患儿为对照组,两组均根据术前影像学检查结果制定手术治疗方案,比较两组手术前后生活质量(PedsQLTM4.0评分)、预后情况(改良Rankin评分),随访3年,统计比较两组并发症发生率和死亡率.结果3D-TOF-MT-MRA检查的图像质量、SNR、CNR均高于MRI检查(P<0.05);MRI、3D-TOF-MT-MRA诊断儿童AVM的曲线下面积(area under the curve,AUC)分别为0.864、0.883,二者联合诊断的AUC最大,为0.939,联合诊断的敏感度、特异度、准确度分别为97.78%、90.00%、95.38%;MRI联合3D-TOF-MT-MRA评估Spetzler-Martin分级的准确度(97.78%)高于MRI单独评估(80.00%)(P<0.05),但与3D-TOF-MT-MRA单独评估的准确度(88.89%)比较,差异无统计学意义(P>0.05);两组术后PedsQLTM4.0评分均高于术前,且观察组高于对照组,mRS评分均低于术前,且观察组低于对照组(P<0.05);观察组并发症总发生率、死亡率(6.82%、4.55%)均低于对照组(22.22%、17.46%)(P<0.05).结论3D-TOF-MT-MRA联合MRI诊断儿童AVM能有效提高诊断敏感度及准确度,且在评估Spetzler-Martin分级方面具有较高可靠性,有助于及时精准判定儿童AVM病情,指导临床制定最佳治疗方法,从而改善患儿预后.

Objective To investigate the value of noninvasive diagnosis for timely and accurate diagnosis and evaluation of occult intracranial arteriovenous malformations(AVM)in children.Methods 65 children with suspected AVM in our hospital from January 2017 to December 2018 were selected as the study group,and both MRI and 3D-TOF-MT-MRA were performed to compare the image quality,signal-to-noise ratio(SNR),and contrast-tonoise ratio(CNR)of the two examination methods,and the digital subtraction angiography(DSA)findings were used as the"gold standard",the value of MRI and 3D-TOF-MT-MRA alone and in combination for the diagnosis of AVM in children was compared and the accuracy of Spetzler-Martin classification was assessed.The quality of life(PedsQLTM 4.0 score)and prognosis(modified Rankin score)were compared between the two groups before and after surgery,and the complication rates and mortality rates were statistically compared between the two groups at a follow-up of three years.Results The image quality,SNR,and CNR of 3D-TOF-MT-MRA examination were higher than those of MRI examination(P<0.05);the area under the curve(AUC)of MRI and 3D-TOF-MT-MRA for diagnosing AVM in children was 0.864 and 0.883,respectively,and the AUC of the combined diagnosis of the two was the largest,at The sensitivity,specificity,and accuracy of the combined diagnosis were 97.78%,90.00%,and 95.38%,respectively;the accuracy of MRI combined with 3D-TOF-MT-MRA in assessing Spetzler-Martin classification(97.78%)was higher than that of MRI alone(80.00%)(P<0.05),but it was different from that of 3D-TOF-MT-MRA alone.MT-MRA alone(88.89%),the difference was not statistically significant(P>0.05);the postoperative PedsQLTM 4.0 score was higher than the preoperative score in both groups,and the study group was higher than the control group,and the mRS score was lower than the preoperative score,and the study group was lower than the control group(P<0.05);the total complication rate and mortality rate in the study group(6.82%,4.55%)were lower than those of the control group(22.22%,17.46%)(P<0.05).Conclusion 3D-TOF-MT-MRA combined with MRI can effectively improve the sensitivity and accuracy of diagnosis of AVM in children,and has high reliability in assessing the Spetzler-Martin classification,which can help determine the AVM condition in children in a timely and accurate manner and guide the clinical development of the best treatment method,thus improving the prognosis of children.