CAJ | 학술논문

目的以DSA为对照,研究3.0 T MR VR重组三维时间飞跃法(3D-TOF) MRA诊断颅内动脉瘤的准确性.方法 411例可疑颅内动脉瘤或其他脑血管疾病的患者在行DSA检查前进行3D-TOF-MRA检查,MRA检查后2周内进行DSA检查,以2D-DSA和VR-DSA结果作为金标准.42例患者被排除(6例因运动伪影被排除,36例因缺少VR-DSA数据被排除).从每例患者有无动脉瘤、每枚动脉瘤和动脉瘤大小(＜3 mm、3～5 mm、＞5 ～10 mm、＞10 mm)3方面评估VR 3D-TOF-MRA对颅内动脉瘤诊断的准确性、敏感度和特异度.结果在最终入选的369例患者中,VR-DSA在246例患者中检测到306枚颅内动脉瘤,123例患者无动脉瘤；3D-TOF-MRA在249例患者中检测到311枚颅内动脉瘤,120例患者无动脉瘤.从患者方面评估,VR 3D-TOF-MRA对颅内动脉瘤的诊断准确性、敏感度和特异度依次为97.6％ (360/369)、99.2％ (242/244)和94.4％ (118/125);从动脉瘤方面评估,VR 3D-TOF-MRA的诊断准确性、敏感度和特异度依次为98.3％ (524/533)、99.3％(304/306)和96.1％ (220/229)；基于动脉瘤大小(＜3 mm)的评估,VR 3D-TOF-MRA的诊断准确性、敏感度和特异度依次为96.4％ (214/222)、98.2％ (112/114)和94.4％ (102/108).结论 VR 3D-TOF-MRA能准确诊断颅内动脉瘤,并可以作为一种无创、无辐射和无须对比剂的检查方法来替代DSA诊断和筛查颅内动脉瘤.
목적 이DSA위대조,연구3.0 T MR VR중조삼유시간비약법(3D-TOF) MRA진단로내동맥류적준학성.방법 411례가의로내동맥류혹기타뇌혈관질병적환자재행DSA검사전진행3D-TOF-MRA검사,MRA검사후2주내진행DSA검사,이2D-DSA화VR-DSA결과작위금표준.42례환자피배제(6례인운동위영피배제,36례인결소VR-DSA수거피배제).종매례환자유무동맥류、매매동맥류화동맥류대소(＜3 mm、3～5 mm、＞5 ～10 mm、＞10 mm)3방면평고VR 3D-TOF-MRA대로내동맥류진단적준학성、민감도화특이도.결과 재최종입선적369례환자중,VR-DSA재246례환자중검측도306매로내동맥류,123례환자무동맥류；3D-TOF-MRA재249례환자중검측도311매로내동맥류,120례환자무동맥류.종환자방면평고,VR 3D-TOF-MRA대로내동맥류적진단준학성、민감도화특이도의차위97.6％ (360/369)、99.2％ (242/244)화94.4％ (118/125);종동맥류방면평고,VR 3D-TOF-MRA적진단준학성、민감도화특이도의차위98.3％ (524/533)、99.3％(304/306)화96.1％ (220/229)；기우동맥류대소(＜3 mm)적평고,VR 3D-TOF-MRA적진단준학성、민감도화특이도의차위96.4％ (214/222)、98.2％ (112/114)화94.4％ (102/108).결론 VR 3D-TOF-MRA능준학진단로내동맥류,병가이작위일충무창、무복사화무수대비제적검사방법래체대DSA진단화사사로내동맥류.
Objective To investigate the diagnostic accuracy of contrast-free three dimensional time-of-flight (3D-TOF-MRA) with VR at 3.0 T in the detection of intracranial aneurysms in a large cohort of patients prospectively.Methods Four hundred and eleven patients with suspected aneurysms and other cerebral vascular diseases received contrast-free 3D-TOF-MRA examinations at 3.0 T MRA 2 weeks prior to DSA examination.2D-DSA and VR-DSA were regarded as the gold standard.Six patients were excluded because of motion artifacts,and 36 patients were excluded due to lack of VR-DSA data.Accuracy,sensitivity an specificity in detecting intracranial aneurysms were determined by patient-,aneurysm-,and aneurysm sizebased (＜ 3 mm,3-5 mm,＞ 5-10 mm,＞ 10 mm) evaluations.Results In 369 enrolled patients,VR-DSA revealed 306 aneurysms in 246 patients (66.7％) and no aneurysm in 123 patients; VR 3D-TOF-MRA revealed 311 aneurysms in 249 patients and no aneurysm in 120 patients.The patient-based evaluation of VR 3 D-TOF-MRA at 3.0T yielded accuracy of 97.6％ (360/369),sensitivity of 99.2％ (242/244),and specificity of 94.4％ (118/125) in the detection of intracranial aneurysms.The aneurysm-based evaluation yielded accuracy of 98.3％ (524/533),sensitivity of 99.3％ (304/306),and specificity of 96.1％(220/229).The evaluation based on aneurysm sizes (＜ 3 mm) yielded accuracy of 96.4％ (214/222),sensitivity of 98.2％ (112/114),and specificity of 94.4％ (102/108).Conclusion VR 3D-TOF-MRA at 3.0 T MR can detect intracranial aneurysms accurately and may replace DSA as a contrast-free,noninvasive and non-radiation-based modality for the diagnosis and screening of intracranial aneurysms.