高分辨率磁共振成像对颅内动脉夹层的诊断价值

摘要

目的 探讨高分辨率磁共振成像(HRGMRI)技术对颅内动脉夹层(IAD)诊断的可行性,旨在提高对 IAD的诊断和认识.方法 回顾性分析43 例可疑 IAD患者的临床资料和影像资料,对患者行 HRGMRI和DSA检查.2 位经验丰富的高年资影像科医师独立分析 HRGMRI图像,神经外科医师对DSA图像进行分析,患者 3 个月~1 年后随访得到最终临床诊断,将 HRGMRI 的诊断结果与最终临床诊断结果以及DSA的诊断结果进行比较.计算 HRGMRI 诊断 IAD的灵敏度,特异度,阳性预测值,阴性预测值,并比较 HRGMRI与DSA对 IAD诊断的一致性.结果 HRGMRI 诊断了 3 2 例 IAD,1 1 例非 IAD,经过随访,最终临床诊断 34 例IAD,9 例非 IAD,HRGMRI诊断 IAD的灵敏度为 9 1.2%,特异度为 88.9%,阳性预测值 9 6.9%,阴性预测值 72.7%,DSA诊断了 30例IAD,13 例非IAD,与 HRGMRI相比,2 种检查的符合率86.0%,McNemer检验 2 种检查无差异(P＝0.687＞0.05),Kappa＝0.654, P＜0.001,2 种检查一致性较好.结论 HRGMRI有优异的软组织对比度和空间分辨率,是颅内动脉管壁成像的一种非侵入性技术,对 IAD的诊断、鉴别诊断及随访起重要的作用.%Objective To investigate the feasibility of the highGresolution MRI (HRGMRI)in diagnosing the intracranial artery dissection (IAD)and to improve radiological diagnostic accuracy in clinical practice.Methods The clinical data and imaging data of 43 patients with suspected IAD were analyzed retrospectively.HRGMRI and DSA examinations were performed.HRGMRI images were reviewed by two experienced radiologists independently,and DSA images were analyzed by a neurosurgeon.FollowGup durations were from 3 months up to 12 months,and then the clinical diagnoses of IAD were made.The sensitivity,specificity,positive predictive value (PPV),and negative predictive value (NPV)of HRGMRI were calculated,and the consistency of HRGMRI and DSA in the diagnosis of IAD was made.Results 32 over 43 patients were detected to be positive by HRGMRI,however,34 of 43 patients were diagnosed as IAD clinically.The sensitivity and specificity of HRGMRI for detecting IAD were 9 1.2% and 88.9%,respectively.The PPV was 96.9%,and the NPV was 72.7%.For DSA,30 patients with IAD were detected and 1 3 patients had negative results.Compared with the HRGMRI (3 2/43),the coincidence rate of two examinations was 86.0%.McNemer test (P＝0.687)indicated that there was no significant difference between two methods.Conclusion HRGMRI has excellent soft tissue contrast and spatial resolution.As a nonGinvasive modality with good tissue contrast and spatial resolution,it plays an important role in the diagnosis,differential diagnosis and followGup of IAD.