不同方法的磁共振静脉成像对颅内静脉窦疾病诊断的比较

目的比较磁共振静脉成像矢状位二维时间飞跃法（2D TOF）、冠状位2D TOF和三维对比增强磁共振静脉成像（3D CE MRV）对颅内静脉窦疾病的诊断价值。方法纳入2011年7月—2012年3月首都医科大学宣武医院神经外科门诊疑有脑静脉系统异常的患者13例,均同时行矢状位和冠状位2D TOF、3D CE MRV扫描,运用最大信号投影（MIP）进行三维重建,诊断结果与DSA对照。计算单独矢状位2D TOF、单独冠状位2D TOF、矢状位联合冠状位2D TOF和3D CE MRV法检测的8个主要静脉结构（上矢状窦、直窦、双侧横窦、双侧乙状窦、双侧横窦与乙状窦的连接）的灵敏度、特异度、阳性预测值、阴性预测值和Kappa值等。结果①单独使用矢状位或冠状位TOF法诊断颅内静脉窦疾病与DSA诊断的结果进行比较,差异均有统计学意义,均P〈0.05,但将两法结合后,差异无统计学意义（χ2M=1.500,P〉0.05）。②以DSA为金标准,3D CE MRV与DSA诊断结果的一致性最高（Kappa=0.933）,灵敏度、特异度、阳性预测值、阴性预测值分别为94.4%、98.8%、94.4%和98.8%。冠状位联合矢状位2D TOF诊断结果与DSA结果的一致性高于单独的矢状位或冠状位2D TOF,Kappa值分别为0.815、0.608、0.635。结论单独应用冠状位2D TOF或矢状位2D TOF诊断颅内静脉窦疾病困难时,应增加另一方向的2D TOF序列,二者协同诊断可提高诊断的准确性;3D CE MRV诊断与DSA呈高度一致性,可作为诊断脑静脉窦疾病的常规检查。

Comparison of the diagnosis of intracranial venous sinus disease with different methods of magnetic resonance venography

Objective To compare the diagnostic value of two-dimensional time-of-flight(2D TOF) magnetic resonance venography in the sagittal plane,2D TOF in the coronal plane,and three-dimensional contrast-enhanced magnetic resonance venography(3D CE-MRV) for intracranial venous sinus disease.Methods Thirteen patients were suspected of having intracranial venous system abnormalities in the Neurosurgical Outpatient Department,Xuanwu Hospital,Capital Medical University were included from July 2011 to March 2012.2D TOF and 3D CE-MRV scan in the sagittal and coronal planes were performed at the same time.Maximum intensity projection(MIP) was used for 3D reconstruction.The diagnostic results were compared with DSA.The sensitivity,specificity,positive predictive value,negative predictive value and Kappa value of the 8 main vein structures(superior sagittal sinus,straight sinus,bilateral transverse sinus,bilateral sigmoid sinus and bilateral transverse-sigmoid sinus junction) of the 2D TOF in the sagittal plane,2D TOF in the coronal plane,and 2D TOF in the sagittal plane in combination with coronal plane were calculated.Results ①Compared to the diagnostic results of DSA,there was significant difference in using the diagnosis with TOF in the sagittal plane or coronal plane alone(all P<0.05),but there was no significant difference after combining the two methods(χ2M =1.500,P>0.05).②Taking DSA as a standard,the consistency of 3D CE-MRV and DSA conclusions was the highest(P<0.01,Kappa=0.933).The sensitivity,specificity,positive predictive value,and negative predicting value were 94.4%,98.8%,94.4%,and 98.8%,respectively.The consistency of the diagnostic results of 2D TOF in the coronal plane in combination with sagittal plane and the DSA conclusions were higher than that of 2D TOF in the coronal plane or 2D TOF in the sagittal plane alone(Kappa values were 0.815,0.635,and 0.608,respectively).Conclusion When it is difficult to diagnose intracranial venous sinus disease with 2D TOF in the coronal plane or 2D TOF in the sagittal plane alone,the 2D TOF sequence of other direction should be added,the collaborative diagnosis of both may improve the accuracy of diagnosis.The diagnosis of 3D CE-MRV and DSA showed a high degree of consistency.They may be used as a routine examination for the diagnosis of cerebral venous sinus disease.