3.0T三维时间飞跃法无增强磁共振血管造影术诊断颅内微小动脉瘤  

Diagnosis of intracranial microaneurysms with contrast-free 3-dimensional time-of-flight magnetic resonance angiography at 3.0T

作　　者：李永东[1] 陆靖[1] 孙贞魁[1] 李明华[1] 谭华侨[1] 王武[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

出　　处：《中国脑血管病杂志》2013年第1期31-37,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(81171440)

摘　　要：目的评价3.0 T三维时间飞跃法无增强磁共振血管造影术(3D-TOF-MRA)诊断颅内微小动脉瘤(直径≤3 mm)的准确性。方法选择513例疑似动脉瘤或因其他脑血管疾病行3D-TOF-MRA检测的患者。经DSA确诊131例患有微小动脉瘤(143个),170例无动脉瘤。以该301例为研究对象,容积重建DSA(VR-DSA)为金标准,评估3D-TOF-MRA在诊断微小动脉瘤中的价值。评价蛛网膜下腔出血(SAH)、动脉瘤的数目及动脉瘤位置对诊断准确性的影响。结果 301例中,3D-TOF-MRA共检测出动脉瘤患者135例(149个)。①以患者为样本数,3D-TOF-MRA检测颅内微小动脉瘤的准确性、敏感性、特异性、阳性预测值、阴性预测值分别为97.3%、98.5%、94.7%、95.6%及97.0%。以动脉瘤为样本数,上述指标分别为96.8%、98.6%、95.3%、94.6%及98.9%。②与无SAH患者比较,3D-TOF-MRA诊断SAH的假阴性率较高,差异有统计学意义,P=0.042;准确率虽有所下降,但差异无统计学意义。③单发或多发动脉瘤对诊断动脉瘤无影响。④3D-TOF-MRA诊断位于大脑前动脉、椎-基底动脉的微小动脉瘤的准确性最高,均为100%,诊断位于颈内动脉系统、大脑中动脉的动脉瘤的准确性分别为97.3%和98.4%。与大脑前动脉、大脑中动脉及椎-基底动脉的微小动脉瘤比较,3D-TOF-MRA诊断颈内动脉系统动脉瘤的准确性略低,P=0.039。结论 3D-TOF-MRA对微小动脉瘤诊断的准确性高,基本可以替代DSA。Objective To evaluate the diagnostic accuracy of three-dimensional time-of-flight magne tic resonance angiography （3D-TOF-MRA） at 3.0 T for intracranial microaneurysms （ ≤ 3 mm in diame- ter）. Methods A total of 513 consecutive patients were detected with 3D-TOF-MRA due to suspected aneurysms or other cerebrovascular disease were enrolled. Digital subtraction angiography （DSA） revealed 131 patients with 143 microaneurysms, and 170 patients without aneurysms. The above 301 patients were used for research objects. Take volume rendering DSA （VR-DSA） as the gold standard, the value in diagno- sing microaneurysms with 3D-TOF-MRA was evaluated. The diagnostic accuracy on subarachnoid hemor- rhage, the number and location of aneurysms were evaluated. Results In the 301 patients, 135 patients with 149 aneurysms were detected with 3D-TOF-MRA. @Based on the patients, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of intracranial microaneurysms detected with 3D-TOF-MRA were 97.3% , 98.5% , 94.7% ,95.6% , and 97.0% , respectively; Based on the mi- croaneurysms, the above indicators were 96.8% , 98.6% , 95.3% ,94.6% , and 98.9% , respectively.（2）Compared to the patients without subarachnoid hemorrhage （SAH）, the false-negative rate of 3D-TOF- MRA for diagnosis of SAH was higher. There was significant difference （ P = 0. 042） ; although the accura- cy rate declined slightly, there was no significant difference. （3）Single or multiple aneurysms had no effect on the diagnosis of aneurysms. （4）The diagnostic accuracy of microaneurysms with 3D-TOF-MRA was high- est in anterior cerebral arteries and vertebral-basilar arteries, and they were all 100%. The accuracy was 97.3% and 98.4% respectively in diagnosis of aneurysms in internal carotid artery system and middle cer- ebral arteries. Compared to the microaneurysms in anterior cerebral arteries, middle cerebral arteries and vertebral-basilar arteries, the accuracy of diagnosing microaneurysms wi

关 键 词：颅内动脉瘤 磁共振血管造影术 微小动脉瘤 容积重建 

分 类 号：R445.2[医药卫生—影像医学与核医学]