3.0T MRA在支架辅助弹簧圈栓塞颅内动脉瘤术后随访中的应用研究

目的 评价3.0T磁共振血管成像（MRA）技术在颅内动脉瘤支架辅助弹簧圈栓塞术后随访中的应用。方法 对32例在笔者医院行颅内动脉瘤支架辅助弹簧圈栓塞术后1~2年的患者进行影像学随访，行3.0T MRA （包括TOF-MRA和CE-MRA）及数字减影血管造影（DSA）检查。以DSA结果为金标准，对MRA的影像质量及结果进行比较分析。结果 3.0T TOF-MRA判断支架辅助弹簧圈栓塞术后动脉瘤复发的敏感度为50%，特异性为100%，总准确率为37.5%，与DSA比较，差异有统计学意义（P<0.01）；对判断载瘤动脉通畅性的准确率为37.5%，与DSA比较，差异有统计学意义（P<0.01）。3.0T CE-MRA对判断动脉瘤复发的敏感度均为50%，特异性均为100%，总准确率为71.9%，与DSA比较，差异无统计学意义（P>0.05）；对判断载瘤动脉通畅性的准确率分别为62.5%，与DSA比较差异有统计学意义（P<0.05）。3.0T TOF-MRA与CE-MRA两组间对评估动脉瘤栓塞术后情况的准确率，差异有统计学意义（P<0.01）。结论 3.0T TOF-MRA在评估支架辅助弹簧圈栓塞颅内动脉瘤术后患者的准确率低；3.0T CE-MRA优于TOF-MRA，与DSA相当，可作为随访的首选手段。3.0T TOF-MRA及CE-MRA对评估载瘤动脉通畅性的准确率均较低，通过优化序列参数的方法可能获得更佳的图像。对于MRA阳性及不确定性结果应个体化分析，必要时行DSA检查。

Application of 3.0T MRA in the Follow-up of Endovascular Embolization for the Intracranial Aneurysm

Objective To evaluate the application of 3.0T Magnetic resonance angiography (MRA) in follow-up the intracranial aneurysm which embolize by stent-assisted coil retrospectively.Methods In our hospital,32 patients who underwent intracranial aneurysm embolization by stent-assisted coil were followed up for one to two year with radiologic examination. All patients were followed up with 3.0T MRA (TOF-MRA + CE-MRA) and Digital subtraction angiography(DSA)examination. DSA served as the golden standard. The MRA image quality and the results were compared.Results The 3.0T TOF-MRA to determine the sensitivity of aneurysm recurrence was 50%, specificity were 100%, accuracy was 37.5%, there was significant difference compared with DSA (P<0.01). The accuracy of the patency of the parent artery was 37.5%, there was significant difference compared with DSA (P<0.01).The 3.0T CE-MRA to determine the sensitivity of aneurysm recurrence was 50%, specificity were 100%, accuracy were 71.9%, there was no significant difference compared with DSA (P>0.05). The accuracy of the patency of the parent artery was 62.5%, there was significant difference compared with DSA (P<0.05).Between the groups of 3.0T TOF-MRA and CE-MRA,there was significantly different to evaluating the accuracy of the aneurysm after embolized (P<0.01).Conclusion 3.0T TOF-MRA in the evaluation of stent assisted coil embolization of intracranial aneurysms with low accuracy. 3.0T CE-MRA was superior to TOF-MRA,and equivalent to DSA. We can use 3.0T CE-MRA as the first choice for follow-up. The accuracy of 3.0T TOF-MRA and CE-MRA to evaluate the patency of the parent artery were low, by optimizing the sequence parameters may obtain a better image. For MRA positive and uncertainty of results should be analyzed individually, if necessary, perform DSA.