非增强3.0T磁共振头颈部3D TOF MRA在椎动脉开口狭窄诊断中的应用价值

摘要

Objective To explore the feasibility and diagnostic accuracy of 3D time-of-flight MR angiography (3D TOF MRA) in the vertebral artery ostium stenosis at 3.0T MR.Methods The 3D TOF MRA and DSA (Digital Subtraction Angiography) images of 35 patients (70 vertebral arteries) who had been clinically diagnosed as suspected vertebral artery ostium stenosis in the hospital from September 2010 to December 2013 were retrospectively reviewed.Results Altogether 31 cases of vertebral artery ostium stenoses were conifrmed by using DSA versus 37 cases as well as 11 false positives and 5 false negatives by using 3D TOF MRA. Taking DSA as the golden standard, the sensitivity, speciifcity, PPV and NPV of 3D TOF MRA in detection of the stenosis in the vertebral ostium were 83.9%, 68.6%, 70.3% and 82.8%, respectively. The Kappa value and Youden index of the 3D TOF MRA and DSA for the detection of vertebral ostial stenosis were 0.519 and 52.5% respectively with statistically signiifcant differences (P<0.001).Conclusion Non-contrast 3.0T 3D TOF MRA could be used for detection of the vertebral artery stenosis. Although it had relatively higher false-positive rate, it demonstrated higher sensitivity and could be taken as a feasible and noninvasive screening tool for the high risk population with related symptoms.%目的：探讨非增强3.0T磁共振头颈部3D TOF MRA在椎动脉开口狭窄诊断中的应用价值。方法回顾性分析2010年9月~2013年12月于我院经临床拟诊为椎动脉开口狭窄的35例患者的3D TOF MRA和数字减影血管造影（DSA）检查资料。结果 DSA确诊31支椎动脉开口狭窄，而3D TOF MRA检出37支椎动脉开口狭窄，11例假阳性，5例假阴性。以DSA为金标准，3D TOF MRA诊断椎动脉开口狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为83.9%、68.6%、70.3%和82.8%。3D TOF MRA和DSA对椎动脉开口狭窄诊断的Kappa值为0.519，Youden指数为52.5%，P＜0.001。结论非增强3.0T磁共振3D TOF MRA可用于检测椎动脉开口狭窄，虽然假阳性率较高，但其敏感性也较高，可用作有症状高危人群的无创、可重复性的筛查方法。