CE-MRA 与TOF-MRA对头颈部动脉瘤诊断价值的对比研究

Compared study of diagnostic value of CE-MRA and TOF-MRA in cerebral and cervical aneurysm

关键词:  磁共振  动脉瘤  血管成像

Key words:  magnetic resonance  aneurysm  angiography

摘要:

［目的］通过造影增强（contrast enhance, MRA，CE-MRA）与时间飞跃技术磁共振血管成像（Time-Of-Flight technique，MRA TOF-MRA）对头颈部动脉瘤诊断的前瞻性对比研究，探讨二者对头颈部动脉瘤的诊断价值。［方法］临床怀疑头颈部动脉瘤患者共100人，经手术或DSA证实头72个动脉瘤病灶，所有患者均行TOF-MRA与CE-MRA检查，对TOF-MRA与CE-MRA的诊断价值进行评价。评价内容：二者对头部动脉瘤诊断的敏感性、特异性、正确率；对合并出血的动脉瘤的显示，对动脉瘤腔内血栓的评价比较。［结果］CE-MRA对头颈部动脉瘤诊断的敏感性97.2%(70/72)、特异性100%(28/28)、正确率( 98%)；TOF-MRA对头颈部动脉瘤诊断的敏感性83.3%(60/72)、特异性46.4%(13/28)、正确率73%，配对χ² 检验显示二者的敏感性（χ²=8.1）、特异性（χ²=13.1）、正确率（χ²=12.1）差异均有显著性意义，P＜0.01；TOF-MRA未显示14例合并出血动脉瘤病灶，CE-MRA对该14个动脉瘤均做出准确评价；TOF-MRA显示37例瘤腔内血栓中16例证实为伪影，CE-MRA对21例瘤腔内血栓均做出准确评价。［结论］TOF-MRA可以作为疑似头部动脉瘤患者的筛选检查，当临床高度怀疑存在颅内动脉瘤而TOF-MRA无异常发现，或由于合并颅内出血TOF-MRA无法明确是否存在动脉瘤，以及需要对瘤腔内是否存在血栓做出准确评价时应选择CE-MRA检查。

Abstract:

［Objective］To prospectively compare the diagnostic value of CE-MRA and TOF-MRA in cerebral and cervical aneurysm.［Methods］One hundred patients with clinical suspected cerebral and cervical aneurysm were enrolled and 72 aneurysms were demonstrated by surgery or DSA. TOF-MRA and CE-MRA were undertaken by every subject for evaluation. Contents of evaluation included the sensitivity, specificity and accuracy in aneurysm diagnosis; exposure of combined hemorrhage and thrombus in the aneurysm sac. ［Results］The sensitivity, specificity and accuracy of CE-MRA in the diagnosis of cerebral and cervical aneurysm were 97.2% (70/72), 100%(28/28) and 98%, while those of TOF-MRA were 83.3%(60/72),46.4%(13/28) and 73%, respectively. Pair χ²-test showed significant difference between them (P<0.01). 14 combining hemorrhage lesions in TOF-MRA were accurately assessed by CE-MRA. Among 37 thromboses in aneurysm sacs, 16 cases were demonstrated to be artifact and 21 thromboses in the aneurysm sacs were correctly evaluated by CE-MRA.［Conclusions］TOF-MRA should be used for screening of cerebral and cervical aneurysm. When no abnormality was found by TOF-MRA in highly-suspected cerebral and cervical aneurysm or cerebral hemorrhage, CE-MRA was recommended. So did the evaluation of thrombus in the aneurysm sac.