3．0TMR三维时间飞跃法MR血管成像与DSA检出颅内动脉瘤的比较  

Comparison of three dimensional time.of-flight MR angiography at 3. 0 T MR and DSA in the detection of intracranial aneurysms

作　　者：顾秀玲[1,2] 李明华[1] 李永东[1] 孙贞魁[1] 谭华桥[1] 王武[1] 顾斌贤[1] 陈元畅[1] 

机构地区：[1]上海交通大学附属上海市第六人民医院介入影像科,200233 [2]浙江省平湖市第一人民医院放射科,嘉兴314200

出　　处：《中华放射学杂志》2013年第1期49-54,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金资助项目（81771440）

摘　　要：目的以DSA为对照，研究3．0TMRVR重组三维时间飞跃法（3D-TOF）MRA诊断颅内动脉瘤的准确性。方法411例可疑颅内动脉瘤或其他脑血管疾病的患者在行DSA检查前进行3D-TOF-MRA检查，MRA检查后2周内进行DSA检查，以2D-DSA和VR-DSA结果作为金标准。42例患者被排除（6例因运动伪影被排除，36例因缺少VR-DSA数据被排除）。从每例患者有无动脉瘤、每枚动脉瘤和动脉瘤大小（〈3mm、3～5mm、〉5～10mm、〉10mm）3方面评估VR3D．TOF-MRA对颅内动脉瘤诊断的准确性、敏感度和特异度。结果在最终入选的369例患者中，VR-DSA在246例患者中检测到306枚颅内动脉瘤，123例患者无动脉瘤；3D-TOF-MRA在249例患者中检测到311枚颅内动脉瘤，120例患者无动脉瘤。从患者方面评估，VR3D-TOF-MRA对颅内动脉瘤的诊断准确性、敏感度和特异度依次为97．6％（360／369）、99．2％（242／244）和94．4％（118／125）；从动脉瘤方面评估，VR3D-TOF-MRA的诊断准确性、敏感度和特异度依次为98．3％（524／533）、99．3％（304／306）和96．1％（220／229）；基于动脉瘤大小（〈3mm）的评估，VR3D-TOF-MRA的诊断准确性、敏感度和特异度依次为96．4％（214／222）、98．2％（112／114）和94．4％（102／108）。结论VR3D-TOF-MRA能准确诊断颅内动脉瘤，并可以作为一种无创、无辐射和无须对比剂的检查方法来替代DSA诊断和筛查颅内动脉瘤。Objective To investigate the diagnostic accuracy of contrast-free three dimensional time-of-flight （3D-TOF-MRA） with VR at 3.0 T in the detection of intracranial aneurysms in a large cohort of patients prospectively. Methods Four hundred and eleven patients with suspected aneurysms and other cerebral vascular diseases received contrast-free 3D-TOF-MRA examinations at 3.0 T MRA 2 weeks prior to DSA examination. 2D-DSA and VR-DSA were regarded as the gold standard. Six patients were excluded because of motion artifacts,and 36 patients were excluded due to lack of VR-DSA data. Accuracy, sensitivity an specificity in detecting intraeranial anemysms were determined by patient-, aneurysm-, and aneurysm size- based （ 〈 3 mm, 3-5 ram, 〉 5-10 ram, 〉 10 mm） evaluations. Results In 369 enrolled patients, VR-DSA revealed 306 anem＇ysms in 246 patients （66.7%） and no aneurysm in 123 patients; VR 3D-TOF- MRA revealed 311 aneurysms in 249 patients and no aneurysm in 120 patients. The patient-based evaluation of VR 3D-TOF-MRA at 3.0T yielded accuracy of 97.6% （360/369）, sensitivity of 99. 2% （242/244）, and specificity of 94. 4% （118/125） in the detection of intracranial aneurysms. The aneurysm-based evaluation yielded accuracy of 98.3% （524/533） , sensitivity of 99.3% （ 304/306 ）, and specificity of 96. 1% （220/229）. The evaluation based on aneurysm sizes （ 〈3 mm） yielded accuracy of 96.4% （214/222）,sensitivity of 98.2% （ 112/114 ）, and specificity of 94. 4% （ 102/108 ）. Conclusion VR 3D-TOF-MRA at 3.0 T MR can detect intracranial aneurysms accurately and may replace DSA as a contrast-free, noninvasive and non-radiation-based modality for the diagnosis and screening of intraeranial aneurysms.

关 键 词：颅内动脉瘤 磁共振成像 血管造影术 数字减影 对比研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]