發(fā)布時(shí)間：2018-05-28 13:51

  本文選題：顱內(nèi)動(dòng)脈瘤 + 磁共振血管造影術(shù)�。� 參考：《中國腦血管病雜志》2017年07期

【摘要】：目的評(píng)價(jià)3.0 T磁共振血管成像(MRA)技術(shù)在顱內(nèi)動(dòng)脈瘤支架輔助彈簧圈栓塞術(shù)后隨訪中的應(yīng)用。方法回顧性連續(xù)納入2013年6月至2015年6月深圳市第六人民醫(yī)院神經(jīng)外科因顱內(nèi)動(dòng)脈瘤破裂致蛛網(wǎng)膜下腔出血行支架輔助彈簧圈栓塞術(shù)患者32例,其中男12例,女20例,平均年齡(56±10)歲,術(shù)前均經(jīng)DSA證實(shí)為單發(fā)顱內(nèi)動(dòng)脈瘤。于術(shù)后1~2年,對(duì)所有患者采用3.0 T時(shí)間飛躍法MRA(TOF-MRA)和對(duì)比劑增強(qiáng)法MRA(CE-MRA)進(jìn)行影像學(xué)隨訪,以DSA結(jié)果為"金標(biāo)準(zhǔn)",對(duì)動(dòng)脈瘤栓塞效果(穩(wěn)定、進(jìn)一步栓塞、再通/復(fù)發(fā))及載瘤動(dòng)脈的通暢性(無狹窄/輕度狹窄、中重度狹窄及閉塞)進(jìn)行比較。結(jié)果 (1)TOF-MRA、CE-MRA及TOF-MRA結(jié)合源圖像評(píng)估支架輔助彈簧圈栓塞術(shù)后動(dòng)脈瘤效果與DSA的一致性比較,分別為一致性較差(Kappa=0.039,P=0.002)、一致性中等(Kappa=0.582,P0.01)、一致性較高(Kappa=0.615,P0.01)。(2)TOF-MRA及CE-MRA評(píng)估支架輔助彈簧圈栓塞術(shù)后載瘤動(dòng)脈通暢性與DSA的一致性均較差(Kappa=0.171,P=0.211;Kappa=0.376,P=0.010)。(3)以DSA結(jié)果為參照,TOF-MRA、TOFMRA結(jié)合源圖像和CE-MRA對(duì)動(dòng)脈瘤栓塞情況判讀的準(zhǔn)確率分別為37.5%(12例)、75.0%(24例)和71.9%(23例),TOF-MRA分別與TOF-MRA結(jié)合源圖像及CE-MRA比較,準(zhǔn)確率的差異均有統(tǒng)計(jì)學(xué)意義(χ~2=9.04,P=0.003;χ~2=7.63,P=0.006);TOF-MRA結(jié)合源圖像與CE-MRA的準(zhǔn)確率差異無統(tǒng)計(jì)學(xué)意義(χ~2=0.08,P=0.777)。(4)以DSA結(jié)果為參照,TOF-MRA和CE-MRA對(duì)載瘤動(dòng)脈通暢性判讀的準(zhǔn)確率分別為37.5%(12例)和62.5%(20例),準(zhǔn)確率的差異無統(tǒng)計(jì)學(xué)意義(χ~2=4.67,P=0.097)。結(jié)論 3.0 T CE-MRA評(píng)估支架輔助彈簧圈栓塞術(shù)后顱內(nèi)動(dòng)脈瘤效果的準(zhǔn)確率優(yōu)于TOF-MRA,可作為隨訪的首選無創(chuàng)檢查,TOF-MRA結(jié)合源圖像與CE-MRA相當(dāng),但TOF-MRA及CE-MRA對(duì)評(píng)估載瘤動(dòng)脈通暢性的準(zhǔn)確性均較低。對(duì)于MRA檢查陽性或不確定性結(jié)果,應(yīng)進(jìn)行個(gè)體化分析,必要時(shí)行DSA檢查。
[Abstract]:Objective to evaluate the application of 3.0 T magnetic resonance angiography (MRAs) in the follow-up of intracranial aneurysm stent-assisted coils embolization. Methods from June 2013 to June 2015, 32 patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysms in neurosurgery department of Shenzhen sixth people's Hospital were treated with stent-assisted coils embolization, including 12 males and 20 females. The mean age was 56 鹵10 years. All patients were confirmed as single intracranial aneurysms by DSA. From 1 to 2 years after operation, all patients were followed up with MRATOF-MRAand contrast enhancement method. The results of DSA were regarded as "gold standard", and the effect of embolization of aneurysms was stable and further embolized. The recanalization / recurrence of the artery and the patency of the aneurysm (no stenosis / mild stenosis, moderate or severe stenosis and occlusion) were compared. Results TOF-MRACE-MRA and TOF-MRA combined with source images were used to evaluate the consistency between stent-assisted coil embolization and DSA. The results of DSA were compared with TOF-MRA and CE-MRA to evaluate the patency of aneurysm carrying artery and the consistency of DSA after stent-assisted coils embolization. The results of DSA were compared with that of TOF-MRAF MRA combined with TOEF-MRA and CE-MRA on the basis of the results of TOF-MRAFMRA combined with TOEF-MRAFMRA and TOEF-MRAFMRA combined with TOEF-MRAFMRA as a reference to the results of TOF-MRA-TOFMRA combined with TOEF-MRAFMRA as a reference to the dynamic imaging and the contrast of CE-MRA with TOEF-MRAFMRA as the reference of TOF-MRAFMRA combined with TOEF-MRAFMRA and CE-MRA as the reference of TOF-MRAFMRA combined with source image and CE-MRA. The diagnostic accuracy of embolization was 37.5% in 12 cases and 75.0% in 24 cases. TOF-MRA was compared with TOF-MRA combined with source image and CE-MRA in 23 cases. The accuracy of TOF-MRA combined with CE-MRA had no statistical significance (蠂 ~ 2 / 29.04 / P 0.003; 蠂 ~ (27.63) / P ~ (0.006) combined with CE-MRA (蠂 ~ (2 / 2) 0.08 ~ (0.08) P ~ (0.777N). Compared with the results of DSA, the accuracy of TOF-MRA and CE-MRA in judging the patency of aneurysm carrying artery were 37.5% and 62.520 cases, respectively. The accuracy of TOF-MRA and CE-MRA were 37.5% and 62.520 cases respectively, and the accuracy of TOF-MRA and CE-MRA were 37.5% and 62.520 cases respectively. There was no statistical difference between the two groups (蠂 ~ (2 +) 4.67%, P = 0.097). Conclusion the accuracy of 3. 0T CE-MRA in evaluating intracranial aneurysms after stent assisted coils embolization is better than that of TOF-MRA. it can be used as the first choice of noninvasive examination for follow-up. The combination of TOF-MRA and source images is comparable to that of CE-MRA. However, the accuracy of TOF-MRA and CE-MRA in evaluating the patency of aneurysm carrier artery was low. For positive or uncertain results of MRA, individualized analysis should be performed, and DSA should be performed when necessary.
【作者單位】： 深圳市第六人民醫(yī)院神經(jīng)外科;
【基金】：深圳市科技創(chuàng)新委員會(huì)項(xiàng)目(JCYJ 20140411092959835)
【分類號(hào)】：R651.12

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