颈动脉非增强高分辨MRI在颈动脉内膜切除术前患者颈动脉狭窄评估中价值的初步研究  

Preliminary Study on Value of Carotid Artery Non-enhanced High-resolution MRI in Evaluating Carotid Stenosis in Patients Before Carotid Endarterectomy

作　　者：房景超 郑园园[2] 王琳[1] 陶立元[3] Fang Jingchao;Zheng Yuanyuan;Wang Lin(Department of Radiology,Peking University Third Hospital,Beijing 100191,China;不详)

机构地区：[1]北京大学第三医院放射科,北京100191 [2]邯郸市中心医院CT/MRI室,邯郸056001 [3]北京大学第三医院临床流行病学研究中心,北京100191

出　　处：《中国微创外科杂志》2025年第3期158-163,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨颈动脉非增强高分辨磁共振成像(magnetic resonance imaging,MRI)对颈动脉狭窄的临床诊断效能。方法回顾分析我院2024年1~9月122例因症状性颈动脉狭窄首次行颈动脉内膜切除术(carotid endarterectomy,CEA)前颈动脉计算机断层扫描血管造影(computed tomography angiography,CTA)与非增强高分辨MRI的资料,根据北美症状性颈动脉内膜切除试验(North American Symptomatic Carotid Endarterectomy Trial,NASCET)标准,由2名影像学医师分别对244支颈动脉的CTA、MRI图像进行狭窄程度测量,以CTA作为对照,以颈动脉狭窄率≥50%、≥70%和100%为界计算MRI诊断颈动脉狭窄的敏感度、特异度、准确率、漏诊率、误诊率。结果以颈动脉狭窄率≥50%为界,MRI敏感度、特异度、准确率、漏诊率、误诊率分别是99.4%(161/162)、100.0%(82/82)、99.6%(243/244)、0.6%(1/162)、0.0%(0/82);以颈动脉狭窄率≥70%为界分别是100.0%(129/129)、100.0%(115/115)、100.0%(244/244)、0.0%(0/129)、0.0%(0/115);以颈动脉狭窄率100%为界,分别是100.0%(30/30)、99.5%(213/214)、99.6%(243/244)、0.0%(0/30)、0.5%(1/214)。不同影像学医师间CTA、MRI所测数值Kappa分析一致性极强(CTA:κ=0.967,P=0.000;MRI:κ=0.956,P=0.000)。结论颈动脉非增强高分辨MRI能准确评估颈动脉狭窄。Objective To investigate clinical diagnostic efficacy of carotid artery non-enhanced high-resolution magnetic resonance imaging(MRI)for carotid artery stenosis.Methods We analyzed 122 cases of symptomatic carotid stenosis who underwent carotid endarterectomy(CEA)for the first time in our hospital from January to September 2024.Preoperative computed tomography angiography(CTA)and non-enhanced high-resolution MRI of the carotid artery were performed.According to the North American Symptomatic Carotid Endarterectomy Trial(NASCET)criteria,two radiologists independently measured degree of stenosis in 244 carotid arteries on CTA and MRI images.The sensitivity,specificity,accuracy,missed diagnosis rate,and misdiagnosis rate of MRI for the diagnosis of carotid stenosis were calculated with CTA as the control and carotid stenosis rates of≥50%,≥70%,and 100%as the thresholds.Results Taking the carotid stenosis rate of≥50%as the threshold,the sensitivity,specificity,accuracy,missed diagnosis rate,and misdiagnosis rate of MRI were 99.4%(161/162),100.0%(82/82),99.6%(243/244),0.6%(1/162),and 0.0%(0/82),respectively.Taking the carotid stenosis rate of≥70%as the threshold,the sensitivity,specificity,accuracy,missed diagnosis rate,and misdiagnosis rate of MRI were 100.0%(129/129),100.0%(115/115),100.0%(244/244),0.0%(0/129),and 0.0%(0/115),respectively.Taking the carotid stenosis rate of 100%as the threshold,the sensitivity,specificity,accuracy,missed diagnosis rate,and misdiagnosis rate of MRI were 100.0%(30/30),99.5%(213/214),99.6%(243/244),0.0%(0/30),and 0.5%(1/214),respectively.The Kappa values(κ)were in good agreement among different radiologist groups(CTA:κ=0.967,P=0.000;MRI:κ=0.956,P=0.000).Conclusion Carotid artery non-enhanced high-resolution MRI can accurately evaluate carotid stenosis.

关 键 词：颈动脉狭窄 颈动脉内膜切除术 CT血管造影 磁共振成像 

分 类 号：R44[医药卫生—诊断学]