颈部黑血管壁成像技术对颈动脉狭窄血运重建术前的评估价值  

Incremental diagnostic value of neck vessel wall imaging technique with T1-weighted three-dimensional variable-flip-angle turbo spin-echo before revascularization in patients with carotid atherosclerotic disease

作　　者：汪振佳 樊昭阳 刘文[1] 卢迷 郑铁晋[4] 寇镭[5] 王硕 于薇[1] Wang Zhenjia;Fan Zhaoyang;Liu Wen;Lu Mi;Zheng Tiejin;Kou Lei;Wang Shuo;Yu Wei(Department of Medical Imaging,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China;Institute of Biomedical Imaging,Cedars Sinai Medical Center,Los Angeles,USA 90048;Department of Otolaryngology Head and Neck Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China;Department of Military Sursery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Vascular,Beijing Anzhen Hospital,Capital Medical University,Beijing100029,China)

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,北京市心肺血管疾病研究所,100029 [2]Cedars Sinai医学中心生物医学影像研究所,美国洛杉矶90048 [3]首都医科大学附属北京安贞医院耳鼻咽喉头颈外科,北京市心肺血管疾病研究所,100029 [4]首都医科大学附属北京安贞医院神经外科,100029 [5]首都医科大学附属北京安贞医院血管科,100029

出　　处：《中华放射学杂志》2019年第8期661-667,共7页Chinese Journal of Radiology

基　　金：北京市自然科学基金联合项目(17L20194);北京市自然科学基金面上项目(7182046).

摘　　要：目的探讨基于T1WI三维变动反转角快速自旋回波(3D T1w-SPACE)序列的颈部黑血管壁成像技术在颈动脉狭窄血运重建术前的评估价值。方法前瞻性收集2016年10月至2018年8月首都医科大学附属北京安贞医院,超声检查提示颈动脉狭窄(单侧或双侧血管狭窄率>50%)拟接受颈动脉内膜剥脱术(CEA)或颈动脉支架治疗术(CAS)治疗的84例有症状的患者,其中31例接受了CEA治疗,53例接受了CAS治疗。84例患者均进行了3D T1w-SPACE检查,接受颈动脉CAS治疗的53例患者同时行DSA检查。在3D T1w-SPACE和DSA图像上进行血管狭窄率、斑块长度测量及有无溃疡判定,在3D T1w-SPACE和病理标本上进行斑块成分分析(分为斑块内出血、富脂质核和钙化)。计算Spearman秩相关系数评价3D T1w-SPACE与DSA间狭窄率测量结果的相关性,计算组内相关系数(ICC)评价3D T1w-SPACE与DSA间测量结果的信度;使用Bland-Altman图法比较3D T1w-SPACE与DSA二者测量结果的一致性。计算3D T1w-SPACE诊断斑块成分及溃疡的一致率、灵敏度、特异度、阳性预测值和阴性预测值。结果以DSA结果为金标准,3D T1w-SPACE测量管腔狭窄率与DSA结果相关性好(r值分别为0.984,P<0.01),两种方法的测量结果信度高,ICC(95%可信区间)分别为0.98(0.96~0.99)。Bland-Altman图提示对于病变长度的测量,两种成像方法具有较强的一致性,95.77%(68/71)的点位于一致性区间内。与DSA对比,3D T1w-SPACE诊断溃疡的灵敏度和特异度分别为89.5%和95.1%。与斑块病理对比,3D T1w-SPACE诊断斑块内出血、富脂质核和钙化的一致率分别为85.7%、82.1%、92.9%;诊断斑块内出血的灵敏度和特异度分别为90.0%和75.0%;诊断富脂质核的灵敏度和特异度分别为83.3%和80.0%;诊断钙化的敏感度和特异度为91.3%和100.0%。但是,3D T1w-SPACE测得的病变长度与DSA测量结果差异有统计学意义(P<0.01)。结论基于3D T1w-SPACE序列的颈部黑血管壁成像技术Objective To determine the feasibility of neck vessel wall imaging technology with three-dimensional variable-flip-angle turbo spin-echo (3D T1w-SPACE) for the detection of carotid atherosclerotic disease before revascularization.Methods Thirty-one patients who underwent carotid endarterectomy (CEA) and fifty-three patients who underwent carotid stenting (CAS) were enrolled prospectively.Neck vessel wall imaging examination were performed in all patients whilecarotid artery DSA were performed in all CAS patients.Quantitative measurements including stenosis,lesion length,and the presence or absence of plaque ulceration obtained with 3D T1w-SPACE and DSA were independently determined.And images of the 3D T1w-SPACE were compared with corresponding histology to identify major plaque components including intraplaque hemorrhage (IPH),lipid rich necrotic core (LRNC),and calcification (CA).The consistency rate,sensitivity,specificity,positive predictive value and negative predictive value were used to assess diagnostic value.Bland-Altman plots,intraclass correlation coefficient (ICC),and Cohen Kappa were determined.Results DSA was served as the reference standard.There was an excellent correlation between 3D T1w-SPACE and DSA images in measuring stenosis (r=0.984,P<0.01) and luminal stenosis [ICC=0.98 (95% confidence interval: 0.96-0.99)].Bland-Altman plots showed that the two examinations were in good consistency in evaluating the extent of stenosis.Sensitivity (89.5%) and specificity (95.1%) was high in 3D T1w-SPACE images compared to DSA for the detection of ulcers.The consistency rate between 3D T1w-SPACE images and histological results for IPH,LRNC and CA detection were 85.7%,82.1% and 92.9%,respectively.Sensitivity and specificity were 90.0% and 75.0% for IPH;83.3% and 80.0% for LRNC;91.3% and 100.0% for CA respectively.However,lesion length measurements by using 3D T1w-SPACE were longer than those measured by using DSA (P<0.01).Conclusion Neck vessel wall imaging technology with 3D T1w-SPACE is a noninvasive and a

关 键 词：颈动脉狭窄 斑块 管壁成像 磁共振成像 

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