MRA、CTA评估脑侧支循环的临床应用价值

摘要

目的 探讨磁共振血管成像(MRA)、计算机断层摄影血管成像(CTA)评估脑侧支循环的临床应用价值.方法 收集2015年1月-2016年12月就诊于兰州军区兰州总医院神经内科行数字减影血管造影(DSA)检查明确为单侧颈内动脉(ICA)或大脑中动脉(MCA) MI段重度狭窄或闭塞的患者64例,其中同期行MRA和DSA检查57例,CTA和DSA检查12例,CTA和MRA检查5例,采用Kappa一致性检验分别评估MRA原始图像(MRA-SI)与DSA、CTA原始图像(CTA-SI)与DSA及MRA-SI与CTA-SI结果的一致性.结果 MRA-SI与DSA(K=0.269,P＜0.05)、MRA-SI与CTA-SI(K=0.282,P＜0.05)评估脑侧支循环结果的一致性均较差.CTA-SI与DSA评估脑侧支循环呈中度一致(K=0.444,P＜0.05).结论 ①DSA仍是评估脑侧支循环的金标准,不能被MRA和CTA取代;②无法行DSA检查时,可考虑行CTA检查予以初步评估.%Objective To appraise the value on clinical application of magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) in assessment of cerebral collateral circulation by evaluating concordance between the two methods and digital subtraction angiography (DSA) respectively.Method From January,2015 to December,2016,sixty-four cases with unilateral internal carotid artery (ICA) or middle cerebral artery (MCA) M1 severe stenosis or occlusion confirmed by DSA,who attended department of neurology of Lanzhou General Hospital,Lanzhou Military Area were collected.Among them,fifty-seven underwent MRA and DSA,twelve underwent CTA and DSA,5 underwent MRA、CTA and DSA.Cohen's Kappa coefficient was used to evaluate the concordance between MRA source imaging (MRA-SI) as well as CTA-SI and DSA,respectively.Results The agreement in assessment of cerebral collateral circulation between MRA-SI and DSA was least favorable(K=0.269,P＜0.05),nor MRA-SI and CTA-SI(K=0.282,P＜0.05).The agreement between CTA-SI and DSA was moderate (K=0.444,P＜0.05).Conclusion DSA that can't be replaced by MRA and CTA is still the golden criteria in assessment of cerebral collateral circulation.If DSA is anable to be taken,CTA can been done for preliminary assessment of collateral circulation.