MRI多模态成像联合常规头颈部CTA对缺血性脑卒中患者大脑中动脉大血管严重狭窄及闭塞的临床诊断价值研究

The Clinical Diagnostic Value of MRI Multimodal Imaging Combined with Conventional Head and Neck CTA for Severe Stenosis and Occlusion of Large Vessels in the Middle Cerebral Artery in Patients with Ischemic Stroke

目的:研究核磁共振(MRI)多模态成像联合常规头颈部CT血管造影(CTA)对缺血性脑卒中患者大脑中动脉大血管严重狭窄及闭塞的临床诊断价值对比。方法:回顾性分析2019年8月至2022年4月期间于我院诊治的102例疑似缺血性脑卒中患者临床资料,所有患者入院24h内均进行常规头颈部CTA、MRI多模态成像以及数字减影血管造影(DSA)检查。以DSA检查结果作为金标准,比较MRI多模态成像、常规头颈部CTA单一诊断以及二者联合诊断大脑中动脉大血管严重狭窄及闭塞的价值。结果:DSA检查结果中,无狭窄-中度狭窄人数56例、重度狭窄/闭塞人数46例,经一致性分析,MRI多模态成像、常规头颈部CTA、二者联合诊断与DSA检查诊断大脑中动脉大血管严重狭窄及闭塞的一致性均较高,Kappa值分别为0.78、0.80、0.94;二者联合诊断的灵敏度及准确率均显著高于单独诊断(P<0.05)。结论:MRI多模态成像、常规头颈部CTA检查对缺血性脑卒中患者大脑中动脉大血管严重狭窄及闭塞情况均具有一定诊断价值,但二者联合诊断价值更高,可作为临床诊断依据。

Objective:To compare the clinical diagnostic value of magnetic resonance imaging(MRI)multimodal imaging combined with conventional head and neck CT angiography(CTA)for severe stenosis and occlusion of the large vessels of the middle cerebral artery in patients with ischemic stroke.Methods:A retrospective analysis was conducted on the clinical data of 102 suspected ischemic stroke patients diagnosed and treated in our hospital from August 2019 to April 2022.All patients underwent routine head and neck CTA examination,MRI multimodal imaging examination,and digital subtraction angiography(DSA)examination within 24 hours after admission.Using DSA examination results as the gold standard,compare the value of MRI multimodal imaging,conventional head and neck CTA single diagnosis,and their combination in diagnosing severe stenosis and occlusion of large vessels in the middle cerebral artery.Results:Among the DSA examination results,there were 56 cases of no stenosis to moderate stenosis and 46 cases of severe stenosis/occlusion.After consistency analysis,the consistency of MRI multimodal imaging,conventional head and neck CTA,combined diagnosis of the two,and DSA examination in diagnosing severe stenosis and occlusion of the large vessels of the middle cerebral artery was high,with Kappa values of 0.78,0.80,and 0.94,respectively;The sensitivity and accuracy of the combined diagnosis were significantly higher than those of individual diagnosis(P<0.05).Conclusion:MRI multimodal imaging and conventional head and neck CTA examination have certain diagnostic value for severe stenosis and occlusion of the large vessels of the middle cerebral artery in patients with ischemic stroke,but the combined diagnostic value of the two is higher and can serve as a clinical diagnostic basis.