脑血管病变三维PC法MRA与动脉DSA的对照研究

目的 :通过与动脉 DSA结果的对照 ,研究三维 PC法 MRA对于检测各类脑血管病变的可信性。方法 :对临床或 MRI表现疑为或需排除脑血管病变的 5 9例兼作 MRA和 DSA检查 ,评价三维 PC法 MRA检测颅内各种血管病变的灵敏度、特异度、假阳性和假阴性率。结果 :MRA检出大于 5 mm的动脉瘤的灵敏度和特异度均达 10 0 %。但小于 5 mm者难以检出 ,使检出总灵敏度下降为 81.8%。 MRA检出 AVM的灵敏度为 92 .3%、特异度为 10 0 % ,畸形血管团及其主要供血动脉和引流静脉均可被 MRA显示。MRA检出颈内动脉 -海绵窦瘘的灵敏度和特异度均为 10 0 % ,表现十分典型。 MRA检出脑血管主干闭塞的灵敏度为 10 0 % ,特异度为 86 .70 % ,高度狭窄者可能过诊为闭塞。 MRA对于颅内占位病变引起的血管移位能全部显示 ,对于细小的肿瘤血管和肿瘤血供无法显示。结论 :MRA在脑血管病变的诊断上显示出很大的应用价值 ,对动静脉畸形、动静脉瘘、血管闭塞和血管移位的检测已有较高的灵敏度和特异度 ,对于较大动脉瘤的显示较好 ,对于小动脉瘤的检出率仍低 ,MRA对于肿瘤血管的检测基本无效。

Comparative Study of 3D-PC MR Angiography and DSA in the Evaluation of Cerebral Vascular Disease

Objective:To compare the reliability of 3D-PC MR angiography with that of intraarterial DSA in the diagnosis of cerebral vascular disease.Methods:59 patients which were suspected to have or should be excluded of cerebral vascular disease underwent both MRA and DSA examination.The sensitivity and specificity of MR angiography was evaluated in a prospective and blinded fashion.Results:MR angiography had a sensitivity and specificity of 100% for detection of cerebral aneurysms which were larger than 5 mm in diameter:Two small aneurysms less than 5 mm in diameter were not detected by MRA.For detection of AVM,sensitivity was 92.3% and specificity was 100.For detection of carotid-cavernous fistula,sensitivity and specificity were both 100%.For detection of vascular occlusion,sensitivity was 100%,and specificity was 86.7%(two cases of severe stenosis was over estimated as occlusion).Sensitivity and specificity were 100% for detection of vessel displacement.MRA did not reliably demonstrated small feeding vessels of intracranial tumors.Conclusion:MRA has high sensitivity and specificity in the diagnosis of AVM,carotid cavernous fistula and vessel displacement.MRA is very sensitive in detection of vessel occlusion and aneurysms which are larger than 5 mm in diameter it can be used as a screening technique for diagnosis of cerebral aneurysms.