3D-T0F MRA对颅内动脉瘤GDC治疗随访的预期评估

目的：评价磁共振血管成像(MRA)在随访43例病人的45个颅内动脉瘤GDC栓塞后的价值。材料和方法：以数字减影血管造影(DSA)作为诊断的金标准，回顾研究43例病人的45个颅内动脉瘤(前循环34个，后循环11个)MRA检查。所有的病人在GDC栓塞治疗后9个月之内的同一周行DSA和MRA检查，这期间不作处理。分析弹簧圈内残余血流、载瘤动脉和邻近动脉血流，MRA以最大强度投影(MIP)重建和源图像为基础。结果：所有病例中，MRA能提供良好的信息。对于动脉瘤的分析，MRA的敏感性、特征性、阳性预测价值、阴性预测价值，诊断弹簧圈内残余血流分别为87．5％、100％、100％、97％，诊断瘤颈的残余血流分别为90％、100％、100％、97％。对于动脉通畅性分析，MRA的敏感性和阴性预测价值，载瘤动脉分别是90．5％和100％，邻近动脉分别是85．7％和100％。结论：在随访GDC栓塞的动脉瘤中，MRA可以作为一个筛选手段，提高检查效率，减少病人的随访风险。

Prospective Evaluation of Time - of - flight MR Angiography in the Follow - up of Intracranial Saccular Aneurysms Treated with Guglielmi Detachable Coils

Purpose: To prospectively evaluate 3D time - of - flight(TOF) MR angiography in the follow - up of 43 cases patients, 45 intracranial saccular aneurysms treated with guglielmi detachable coils. Materials and Methods: 43 patients with 45 aneurysms were included in this prospective study. 34 aneurysms were located in the anterior circulation and 11 in posterior circulation. All patients underwent 3D TOF MRA and digital subtraction angiography (DSA) in the same week within 9 months treated with GDCs. No clinical events occurred during the follow - up. We analyzed residual flow within the coil mass, at the aneurismal neck and the patency of the parent and adjacent arteries on MRA and DSA. MRA analysis was based on MIPPED and source images. DSA was our gold standard. Results: In all cases, the quality of MRA was good enough to be informative. In aneurismal analysis, the sensitivity, specificity, positive predictive value, and negative predictive value of MRA were, 87.5% , 100% , 100% , and 97% respectively to diagnose residual flow within the coil mass and 90, 100, 100, and 97% to diagnose residual flow within the a-neurismal neck. In arterial analysis, sensitivity and positive predictive value of MRA were 90.5 and 100% to diagnose patency of the parent artery and 85. 7 and 100% to diagnose patency of the adjacent arteries. Conclusion: In the follow - up of intracranial aneurysms treated with GDCs, 3D TOF MRA could be used as a screening test to select patients for further evaluation with DSA and thus could improve patient follow - up in terms of risk - benefit.