基于杂合动脉自旋标记改进型静音MR血管成像对颅内动脉狭窄闭塞性疾病的成像价值  

Imaging value of intracranial steno-occlusive disease based on silent MR angiography modified with hybrid-arterial spin labeling

作　　者：王丽娟 尚松安[1] 叶靖[1] 向玲玲 邓紫竹 郜言坤 罗先富 张洪英[1] 吴晶涛[1] Wang Lijuan;Shang Song′an;Ye Jing;Xiang Lingling;Deng Zizhu;Gao Yankun;Luo Xianfu;Zhang Hongying;Wu Jingtao(Department of Radiology,Northern Jiangsu People′s Hospital,Yangzhou 225001,China)

机构地区：[1]江苏省苏北人民医院放射科,扬州225001

出　　处：《中华放射学杂志》2021年第10期1029-1035,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(81571652);江苏省“333工程”培养基金(BRA2017154);扬州市社会发展项目(YZ2018059)。

摘　　要：目的探讨基于杂合动脉自旋标记(ASL)改进型静音MRA技术在颅内动脉狭窄性疾病成像中的稳定性以及可行性。方法收集2019年9月至2020年5月经苏北人民医院神经内科临床怀疑的颅内血管狭窄及闭塞患者35例,分别进行静音MRA以及基于杂合ASL技术改进型静音MRA,评估2种MRA检查的采集噪声(噪声测量、主观评分)。2名神经放射专家采用双盲、完全随机法分别对2种MRA图像中的颅内动脉(包括颈内动脉、椎-基底动脉、大脑前动脉、大脑中动脉及大脑后动脉)进行图像质量评分及信噪比测量。采用独立样本t检验比较各节段2次MRA检查图像的图像质量、信噪比差异。2名专家对已证实的颅内动脉狭窄部位进行狭窄程度评级。采用Kappa检验评估观察者及检查方法间一致性。结果改进型静音MRA与静音MRA采集噪音差异无统计学意义(P>0.05)。在测量的所有5个动脉节段中,颈内动脉[(4.40±0.49)分]、大脑前动脉[(4.30±0.33)分]、大脑中动脉[(4.46±0.34)分]于改进型静音MRA的图像质量评分高于静音MRA图像(分别为(4.02±0.43)分、(4.02±0.31)分、(4.02±0.31)分,t分别为2.825、2.877、1.683,P<0.05),改进型静音MRA颈内动脉(9.11±1.23)、大脑中动脉(8.77±1.87)的图像信噪比高于静音MRA(分别为7.83±1.33、8.06±2.67,t分别为11.154、3.268,P<0.05)。CTA共诊断颅内血管狭窄患者24例(38处)。改进型静音MRA(Kappa=0.89,95%CI 0.82~0.95)和静音MRA(Kappa=0.85,95%CI 0.77~0.92)评估脑血管狭窄程度的观察者间一致性极高。改进型静音MRA对动脉狭窄程度评级结果与CTA结果一致性极高(Kappa=0.92,95%CI 0.87~0.98),静音MRA对狭窄程度评级结果与CTA结果一致性极高(Kappa=0.85,95%CI 0.77~0.92)。结论改进型静音MRA在保持低噪特性的基础上,通过高效标记提升了成像质量以及信号均匀性,具备可行性。在颅内狭窄闭塞性疾病的诊断中,改进型静音MRA成像稳定,一定程度上提�Objective To investigate the stability and feasibility of improved silent MRA technique based on hybrid-arterial spin labeling(ASL)for imaging intracranial arterial stenosis.Methods From September 2019 to May 2020,totally 35 patients with suspected intracranial vascular stenosis in Department of Neurology of Northern Jiangsu People′s Hospital were enrolled in this study.Silent MRA and improved silent MRA based on hybrid-ASL technique were performed respectively.The acquisition noise(noise measurement and subjective score)of two kinds of MRA examination were evaluated respectively.Two neuroradiologists performed image quality scoring and signal-to-noise ratio(SNR)measurement of intracranial arteries(including internal carotid artery,vertebrobasilar artery,anterior cerebral artery,middle cerebral artery,and posterior cerebral artery)in the two kinds of MRA images using a double-blind,completely randomized method.Independent sample t-test was used to compare the image quality and SNR of two kinds of MRA images in each segment.Two experts assessed the degree of stenosis at the site of confirmed intracranial artery stenosis.Kappa test was used to assess interobserver and intermodel agreement.Results There was no significant difference in acquisition noise between improved silent MRA and silent MRA(P>0.05).In all five segments measured,the image quality scores of internal carotid artery[(4.40±0.49)scores],anterior cerebral artery[(4.30±0.33)scores]and middle cerebral artery[(4.46±0.34)scores]in improved silent MRA were higher than those in silent MRA images[(4.02±0.43)scores,(4.02±0.31)scores,(4.02±0.31)scores;t=2.825,2.877,1.683,all P<0.05)].The SNR of internal carotid artery(9.11±1.23)and middle cerebral artery(8.77±1.87)in improved silent MRA images was higher than that in silent MRA images(7.83±1.33,8.06±2.67,respectively;t=11.154,3.268,both P<0.05).A total of 24 patients(38 lesions)with intracranial vascular stenosis were diagnosed by CTA.Improved silent MRA(Kappa=0.89,95%CI 0.82-0.95)and silent MRA(Ka

关 键 词：磁共振成像 噪声 动脉自旋标记 颅内血管狭窄 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]