高分辨率血管壁成像和静音磁共振血管造影在颅内动脉瘤栓塞术后复查中的临床价值研究  

Clinical value of high-resolution vessel wall imaging and silent magnetic resonance angiography in re-examination after intracranial aneurysm embolization

作　　者：曾朝霞[1] 张照涛 唐小平[1] 应洪新 徐斯维 龚良庚[1] Zeng Zhaoxia;Zhang Zhaotao;Tang Xiaoping;Ying Hongxin;Xu Siwei;Gong Lianggeng(Medical Imaging Center,the Second Affiliated Hospital of Nanchang University,Nanchang 330001,China)

机构地区：[1]南昌大学第二附属医院医学影像中心,南昌330001

出　　处：《中华神经科杂志》2023年第1期39-47,共9页Chinese Journal of Neurology

基　　金：江西省卫生健康委科技计划(202130501);国家自然科学基金(82060557);江西省教育厅科学技术研究项目(GJJ210250)。

摘　　要：目的探讨时间飞跃法磁共振血管造影(TOF-MRA)、静音磁共振血管造影(SilenZ-MRA)和高分辨率血管壁成像(HR-VWI)在颅内动脉瘤栓塞术后无创性评估中的临床应用价值。方法收集2021年2月至2022年2月在南昌大学第二附属医院已接受颅内动脉瘤栓塞术的术后患者39例, 其中男性8例、女性31例;年龄29~86(54.50±11.80)岁。采用Kruskal-Wallis检验分别比较TOF-MRA、SilenZ-MRA、HR-VWI的图像质量评分和支架段管腔狭窄率评估结果。以DSA为参考标准, 采用受试者工作特征(ROC)曲线分别分析TOF-MRA、SilenZ-MRA和HR-VWI 3种MRI血管成像技术对动脉瘤术后栓塞状态的诊断价值。结果 TOF-MRA、SilenZ-MRA和HR-VWI图像质量评分分别为2(1, 3)、4(3, 4)、4(4, 4)分, 差异有统计学意义(H=80.78, P<0.05), 两两比较结果如下:TOF-MRA 比SilenZ-MRA, P<0.017;TOF-MRA比HR-VWI, P<0.017;SilenZ-MRA 比HR-VWI, P>0.017。采用TOF-MRA、SilenZ-MRA、HR-VWI和DSA测量每个病例支架段管腔狭窄率, 结果支架段管腔狭窄率分别为45.00%(29.60%, 61.05%)、17.60%(10.80%, 26.80%)、13.35%(8.90%, 15.95%)和7.95%(4.80%, 11.25%), 差异有统计学意义(H=67.96, P<0.05)。TOF-MRA、SilenZ-MRA、HR-VWI分别和DSA进行比较, 结果如下:TOF-MRA比DSA, P<0.017;SilenZ-MRA比DSA, P<0.017;HR-VWI比DSA, P>0.017。DSA复查动脉瘤术后栓塞状态发现, 有12个(27.91%, 12/43)动脉瘤栓塞不完全, 31个(72.09%, 31/43)动脉瘤栓塞完全。TOF-MRA、SilenZ-MRA和HR-VWI评估动脉瘤术后是否完全栓塞的曲线下面积分别为0.75、1.00和0.94, TOF-MRA与HR-VWI(Z=2.53, P<0.05)及TOF-MRA与SilenZ-MRA(Z=3.32, P<0.05)相比差异有统计学意义。结论 HR-VWI可以清晰显示载瘤动脉支架段管腔, 评价支架段动脉管壁情况及管腔通畅与否。SilenZ-MRA评估动脉瘤术后栓塞状态明显优于TOF-MRA, 且在瘤颈显示上略优于HR-VWI。联合应用HR-VWI和SilenZ-MRA对颅内动脉瘤栓塞术后无创性评估具有一定的临床意义。Objective To explore the clinical application of time of flight-magnetic resonance angiography(TOF-MRA),silent magnetic resonance angiography(SilenZ-MRA)and high-resolution vessel wall imaging(HR-VWI)in non-invasive evaluation of intracranial aneurysm after embolization.Methods From February 2021 to February 2022,39 patients,including 8 males and 31 females,who were 29-86(54.50±11.80)years old and had received intracranial aneurysm embolization were collected in the Second Affiliated Hospital of Nanchang University.Kruskal-Wallis test was used to compare the image quality score and the evaluation results of lumen stenosis rate in the stent segments by TOF-MRA,SilenZ-MRA and HR-VWI.The diagnostic value of TOF-MRA,SilenZ-MRA and HR-VWI was analyzed by receiver operating characteristic(ROC)curve with DSA as the reference standard.Results The image quality scores of TOF-MRA,SilenZ-MRA and HR-VWI were 2(1,3),4(3,4)and 4(4,4),respectively,with statistically significant difference(H=80.78,P<0.05).The pairwise comparison results were as follows:TOF-MRA vs SilenZ-MRA,P<0.017;TOF-MRA vs HR-VWI,P<0.017;SilenZ-MRA vs HR-VWI,P>0.017.The lumen stenosis rates of stent segments measured by TOF-MRA,SilenZ-MRA,HR-VWI and DSA were 45.00%(29.60%,61.05%),17.60%(10.80%,26.80%),13.35%(8.90%,15.95%)and 7.95%(4.80%,11.25%),respectively,with statistically significant difference(H=67.96,P<0.05).The results of comparison between TOF-MRA,SilenZ-MRA,HR-VWI and DSA were respectively as follows:TOF-MRA vs DSA,P<0.017;SilenZ-MRA vs DSA,P<0.017;HR-VWI vs DSA,P>0.017.DSA review showed that 12(27.91%,12/43)aneurysms were not completely embolized,and 31(72.09%,31/43)aneurysms were completely embolized.The area under the curve of TOF-MRA,SilenZ-MRA and HR-VWI for evaluating the postoperative complete embolization of aneurysm was 0.75,1.00 and 0.94,respectively,with statistically significant differences between TOF-MRA and HR-VWI(Z=2.53,P<0.05)as well as between TOF-MRA and SilenZ-MRA(Z=3.32,P<0.05).Conclusions HR-VWI can clearly display the stent-se

关 键 词：颅内动脉瘤 磁共振成像 磁共振血管造影术 血管造影术 数字减影 

分 类 号：R651.12[医药卫生—外科学] R445.2[医药卫生—临床医学]