3D-TOF-MT-MRA联合MRI对儿童颅内隐匿性动静脉畸形的诊断价值  

Diagnostic value of 3D-TOF-MT-MRA combined with MRI in the diagnosis of intracranial occult arteriovenous malformations in children

作　　者：唐晓娜[1] 杨士斌[2] 崔晓普[1] 赵青[1] 孙素真[1] Tang Xiaona;Yang Shibin;Cui Xiaopu;Zhao Qing;Sun Suzhen(Department of Neurology,Hebei Children's Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院神经内科,石家庄050031 [2]河北医科大学第二医院儿科

出　　处：《脑与神经疾病杂志》2023年第12期727-732,共6页Journal of Brain and Nervous Diseases

基　　金：河北省医学科学课题研究计划(20211738)。

摘　　要：目的探究三维时间飞跃法-磁化转移-磁共振血管成像(3D-TOF-MT-MRA)联合磁共振成像(MRI)诊断儿童颅内隐匿性动静脉畸形(AVM)的价值。方法选取2021年1月-2022年8月河北省儿童医院神经内科96例疑似AVM患儿,均行MRI、3D-TOF-MT-MRA检查,由两名影像科副主任医师对MRI、3D-TOF-MT-MRA检查图像质量进行主观、客观评价,分析两种方法图像质量的一致性,比较两种方法图像质量。以数字减影血管造影(DSA)检查结果为“金标准”,比较分析MRI、3D-TOF-MTMRA单独及联合诊断AVM、联合评估Spetzler-Martin分级的价值。对确诊的AVM患儿拟行伽玛刀治疗,比较MRI联合3D-TOF-MT-MRA与DSA评估术前定位影像效果评分、勾画治疗靶体积。结果3D-TOFMT-MRA图像的信噪比(SNR)、对比度噪声比(CNR)均高于MRI图像(P<0.05);3D-TOF-MTMRA图像的血管可视化、饱和伪影评分均高于MRI图像(P<0.05);两名医师对MRI图像的血管可视化、饱和伪影评分评估的一致性组内相关系数值ICC分别为0.912(95%CI:0.815~0.973)、0.916(95%CI:0.820~0.981)(P<0.05);MRI联合3D-TOF-MT-MRA诊断AVM的敏感度(98.44%)、准确度(95.83%)均高于MRI(78.13%、83.33%)、3D-TOF-MT-MRA(85.94%、87.50%)单独诊断(P<0.05);MRI联合3D-TOF-MT-MRA评估Spetzler-Martin分级与DSA评估结果的一致性Kappa值为0.959(95%CI:0.828~1.090),符合率为96.83%(P<0.05);MRI联合3D-TOF-MT-MRA与DSA评估术前定位影像效果评分、勾画治疗靶体积比较(P>0.05)。结论MRI联合3D-TOF-MT-MRA在儿童AVM诊断方面具有较高敏感度和准确度,能准确评估Spetzler-Martin分级,且评估术前定位影像效果评分、勾画治疗靶体积与DSA接近,有助于指导临床制定手术方案。Objective To investigate the value of three-dimensional time-of-flight method-magnetization transfer-magnetic resonance angiography(3D-TOF-MT-MRA)combined with magnetic resonance imaging(MRI)for the diagnosis of intracranial occult arteriovenous malformations(AVM)in children.Methods 96 cases of children with suspected AVM were selected from January 2021 to August 2022 in the Department of Neurology,Hebei Children's Hospital,all of whom underwent MRI and 3D-TOF-MT-MRA examinations,and the image quality of MRI and 3D-TOF-MT-MRA examinations were subjectively and objectively evaluated by two deputy chief physicians of the imaging department to analyze the consistency of image quality of the two methods and compare the image quality of the two methods.Digital subtraction angiography(DSA)findings were used as the"gold standard"to compare the value of MRI and 3D-TOF-MT-MRA alone and in combination for the diagnosis of AVM and the assessment of Spetzler-Martin classification.For children with confirmed AVM to be treated with gamma knife,MRI combined with3D-TOF-MT-MRA was compared with DSA to evaluate the preoperative localization imaging effect score and outline the treatment target volume.Results The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of 3D-TOFMT-MRA images were higher than those of MRI images(P<0.05);the vascular visualization and saturation artifact scores of 3D-TOF-MT-MRA images were higher than those of MRI images(P<0.05);the agreement between the 2physicians in assessing the vascular visualization and saturation artifact scores of MRI images intra-group correlation coefficient(ICC)values of 0.912(95%CI:0.815-0.973)and 0.916(95%CI:0.820-0.981),respectively(P<0.05).The sensitivity(98.44%)and accuracy(95.83%)of MRI combined with 3D-TOF-MT-MRA for the diagnosis of AVM were higher than those of MRI(78.13%,83.33%)and 3D-TOF-MT-MRA(85.94%,87.50%)alone(P<0.05);MRI combined with 3D-TOF-MT-MRA assessment The Kappa value of agreement between Spetzler-Martin grading and DSA assessment was 0.959(95%CI:0.

关 键 词：颅内动静脉畸形 磁共振成像 三维时间飞跃法-磁化转移-磁共振血管成像 诊断 

分 类 号：R743.4[医药卫生—神经病学与精神病学]