脊髓高时间/高空间分辨率CE-MRA在硬脊膜动静脉瘘诊断中的应用价值  

Value of spinal high temporal/high spatial resolution CE-MRA in the diagnosis of spinal dural arteriovenous fistulas

作　　者：苏逸航 聂吉林[1] 陈斌[1] 杨帅 陈常勇[1] 廖伟华[1] 赵晴 SU Yihang;NIE Jilin;CHEN Bin;YANG Shuai;CHEN Changyong;LIAO Weihua;ZHAO Qing(Department of Radiology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院放射科,长沙410008

出　　处：《中南大学学报(医学版)》2024年第12期1927-1933,共7页Journal of Central South University :Medical Science

基　　金：湖南省科技创新计划(2020RC4007)。

摘　　要：目的:数字减影血管造影(digital subtraction angiography,DSA)是目前诊断硬脊膜动静脉瘘(spinal duralarteriovenous fistulas,SDAVF)的金标准,然而DSA为有创检查,还存在电离辐射、碘对比剂过敏等不良反应。高时间/高空间分辨率对比增强磁共振血管成像(contrast-enhanced magnetic resonance angiography,CE-MRA)检查可实现高时间/高空间分辨率的多期动态对比剂增强MRI。本研究旨在评估脊髓高时间/高空间分辨率CE-MRA对SDAVF的诊断价值。方法:回顾性收集2021年1月1日至2024年1月1日期间在湘雅医院进行脊髓常规MRI及高时间/高空间分辨率CE-MRA检查,并在2项检查后90 d内进行DSA或手术的患者资料。由2位高年资影像科医师独立观察和评估所有常规脊髓MRI及CE-MRA图像,并将评估结果与“金标准”DSA检查结果对照计算常规脊髓MRI、CE-MRA诊断SDAVF的敏感度、特异度。对脊髓常规MRI、CE-MRA检查与DSA检查结果进行Kappa一致性检验。采用受试者操作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)评价二者对SDAVF的诊断价值。结果:共纳入符合条件的患者60例,其中SDAVF 47例,无SDAVF13例。常规MRI检查结果有3例假阴性、1例假阳性;CE-MRA检查结果有2例假阳性、无假阴性。常规MRI诊断SDAVF的敏感度、特异度分别为93.62%、92.31%,CE-MRA诊断SDAVF的敏感度、特异度分别为100%、84.62%。将脊髓后根髓动脉误为供血动脉是造成CE-MRA假阳性的主要原因。CE-MRA图像可清晰显示大部分供血动脉,瘘口定位的准确率为74.47%(35/47)。Kappa一致性检验分析结果表明常规MRI和CE-MRA检查的Kappa值分别为0.814与0.896(均P<0.001),一致性均较好,且CE-MRA优于常规MRI。常规MRI和CE-MRA检查诊断SDAVF的曲线下面积(area under the curve,AUC)分别为0.930与0.923(均P<0.05)。结论:高时间/高空间分辨率脊髓CE-MRA是SDAVF可靠、无创的检查方法,具有较高的敏感度,能�Objective:Digital subtraction angiography(DSA)is the current gold standard for diagnosing spinal dural arteriovenous fistulas(SDAVF).However,DSA is invasive and associated with risks such as ionizing radiation and iodine contrast allergy.Contrast-enhanced magnetic resonance angiography(CE-MRA)with high temporal/high spatial resolution allows dynamic multiphase contrast-enhanced imaging with excellent detail.This study aims to evaluate the diagnostic value of spinal CE-MRA with high temporal/high spatial resolution for SDAVF.Methods:Clinical data were retrospectively collected from patients who underwent both conventional spinal MRI and high temporal/high spatial resolution CE-MRA at Xiangya Hospital between January 1,2021,and January 1,2024,and who subsequently underwent DSA or surgery within 90 days.Two experienced radiologists independently reviewed all conventional MRI and CE-MRA images.The sensitivity and specificity of conventional MRI and CE-MRA for diagnosing SDAVF were calculated against the gold standard DSA findings.Kappa statistics were used to evaluate the consistency of MRI and CE-MRA compared to DSA.The diagnostic value was further assessed by calculating the area under curve(AUC)of the receiver operating characteristic(ROC).Results:A total of 60 patients were included,of whom 47 were diagnosed with SDAVF and 13 were not.Conventional MRI had 3 false negatives and 1 false positive;CE-MRA had 2 false positives and 0 false negative.The sensitivity and specificity of conventional MRI were 93.62%and 92.31%,respectively.CE-MRA demonstrated 100%sensitivity and 84.62%specificity.The main cause of false positives was the misidentification of posterior spinal arteries as feeding arteries.CE-MRA clearly displayed most feeding arteries,and the accuracy of fistula localization was 74.47%(35/47).Kappa values for conventional MRI and CE-MRA were 0.814 and 0.896,respectively(both P<0.001),indicating good agreement,with CE-MRA outperforming conventional MRI.The AUCs for diagnosing SDAVF were 0.930 for conventional M

关 键 词：硬脊膜动静脉瘘 磁共振成像 高时间/高空间分辨率 对比增强磁共振血管成像 数字减影血管造影 敏感度 供血动脉 

分 类 号：R44[医药卫生—诊断学]