静音MR血管成像对儿童脑动静脉畸形的诊断价值

The application of silent MR angiography in the imaging of brain arteriovenous malformation in children

目的探讨静音MR血管成像(MRA)在儿童脑动静脉畸形(BAVM)成像中的应用价值。方法回顾性收集2020年4月至2022年5月首都医科大学宣武医院经数字减影血管造影(DSA)确诊的BAVM患儿20例,所有病例均在同一次检查中以静音MRA及时间飞跃法MRA(TOF MRA)采集图像。对BAVM的供血动脉、畸形血管团及引流静脉均采用4分法评估图像质量。采用Wilcoxon秩和检验比较静音MRA和TOF MRA图像质量评分的差异。采用Kappa一致性检验评估静音MRA、TOF MRA在显示血管构筑特征及Spetzler-Martin分级中与DSA的一致性。结果在20个BAVM中,静音MRA和TOF MRA显示畸形血管团[分别为(2.75±0.55)、(2.20±0.70)分]与引流静脉[分别为(2.60±0.68)、(2.20±0.77)分]的图像质量评分差异有统计学意义(Z值分别为-3.05、-2.13,P值分别为0.002、0.033)。静音MRA在畸形团大小分级、深静脉引流、相关动脉瘤以及Spetzler-Martin分级上,与DSA一致性均为极好(Kappa值分别为0.91、1.00、0.83、0.93);TOF MRA的一致性仅为一般至中等(Kappa值分别为0.46、0.59、0.35、0.47)。结论静音MRA的图像质量优于TOF MRA,并能更好地评估儿童BAVM血管构筑特征和Spetzler-Martin分级。

Objective To explore the application value of silent MR angiography(MRA)in imaging of brain arteriovenous malformation(BAVM)in children.Methods A total of 20 children with BAVM confirmed by digital subtraction angiography(DSA)were retrospectively collected.All children were imaged by silent MRA and time-of-flight MRA(TOF MRA)in the same examination.The image quality of feeding artery,nidus and drainage vein of BAVM was evaluated using the four-point method.Wilcoxon rank-sum test was utilized to compare the image quality scores between silent MRA and TOF MRA.Weighted Kappa statistics used to evaluate the inter-modality agreement of silent MRA and TOF MRA with DSA in displaying of angioarchitecture characteristics and determination of Spetzler-Martin grading.Results Among the 20 BAVMs,significant differences in image quality scores of the nidus(2.75±0.55 versus 2.20±0.70)and drainage vein(2.60±0.68 versus 2.20±0.77)were observed between silent MRA and TOF MRA(Z=-3.05,P=0.002;Z=-2.13,P=0.033,respectively).The agreement between silent MRA and DSA was excellent in nidus size grading,deep venous drainage,associated aneurysm and SM grading(Kappa 0.91,1.00,0.83 and 0.93,respectively);The agreement between TOF MRA and DSA was fair to moderate(Kappa 0.46,0.59,0.35 and 0.47,respectively).Conclusions Silent MRA showes better image quality compared to TOF MRA and improves the evaluation of angioarchitecture characteristics and Spetzler-Martin grading of BAVMs in children.