3D-SPACE序列结合3D-TOF MR血管成像在颅内动脉瘤支架辅助弹簧圈栓塞术后随访中的应用

目的探讨三维T1加权序列可变反转角度快速自旋回波序列(3D T1-SPACE)结合三维时间飞跃法MR血管成像(3D-TOF MRA)在颅内动脉瘤支架辅助弹簧圈栓塞术后患者随访中的应用价值。方法前瞻性收集2017年12月至2018年10月河南省人民医院收治的25例因颅内动脉瘤接受支架辅助弹簧圈栓塞术的患者,均为宽颈动脉瘤。术后6~10个月所有患者均行3D-TOF MRA、3D T1-SPACE序列MR扫描和DSA检查。分别使用3D-TOF MRA和DSA以Raymond分级法评价瘤腔栓塞情况,使用3D-TOF MRA和3D T1-SPACE序列以4分法评价载瘤动脉支架内管腔显示情况。采用配对设计的Wilcoxon秩和检验比较动脉瘤栓塞程度分级和支架内管腔显示情况。以DSA为金标准,计算3D-TOF MRA评估动脉瘤残留的特异度及准确率。结果术后6~10个月随访,对于动脉瘤闭塞情况,DSA造影显示Raymond 1级23例,2级1例,3级1例;3D-TOF MRA 1级21例,2级3例,3级1例;差异无统计学意义(Z=-0.557,P=0.577),其中有4例患者两种评估方法结果不一致。对于载瘤动脉支架内管腔情况的显示,3D-TOF MRA评分3分14例,2分8例,1分3例;3D T1-SPACE序列25例均为4分,3D T1-SPACE优于3D-TOF MRA(Z=-4.484,P<0.001)。以DSA为金标准,3D-TOF MRA结合原图像评估动脉瘤栓塞情况的特异度为86.9%(20/23),准确率为84.0%(21/25)。结论3.0 T MR 3D T1-SPACE序列可清晰显示支架内管腔,能准确判断支架内血管的通畅情况,3D-TOF MRA可充分评估动脉瘤瘤腔有无残留。将上述两种MRI血管成像技术相结合,可用于动脉瘤支架辅助栓塞术后的随访。

Application of 3D-SPACE sequence combined with 3D-TOF MR angiography in follow-up for intracranial aneurysm after stent-assisted coil embolization

Objective To explore the application value of three dimensional T1 weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions(3D T1-SPACE)combined with three dimensional time of flight MR angiography(3D-TOF MRA)in the follow-up of stent-assisted coil embolization for intracranial aneurysm.Methods From December 2017 to October 2018,25 patients with intracranial aneurysm who underwent stent-assisted coil embolization in Henan Provincial People′s Hospital were enrolled.All of them had wide neck intracranial aneurysms and were followed up for 6 to 10 months after endovascular treatment using 3D-TOF MRA,3D T1-SPACE sequence and DSA.The DSA and 3D-TOF MRA were performed to evaluate aneurysm remnants using Raymond grade scale.Meanwhile,3D-TOF MRA and 3D T1-SPACE sequence were performed to evaluate in-stent lumen visibility using the 4-point scale.The paired sample Wilcoxon test was used to evaluate the aneurysm remnants and the parent artery patency.DSA was used as the gold standard to calculate the specificity and accuracy of the aneurysm remnants evaluated by 3D-TOF MRA.Results Six to ten months′follow up after the procedure,for aneurysm occlusion,the Raymond grade scale of the 25 patients evaluated by DSA indicated grade 1 in 23 patients,2 in 1 and 3 in 1.For patients evaluated by 3D-TOF MRA,the results demonstrated grade 1 in 21 patients,2 in 3 and 3 in 1.There was no difference between the 2 methods(Z=-0.557,P=0.577).The in-stent lumens of parent vessel evaluated by 3D-TOF MRA showed that there were 14 patients with grade 3,8 patients with grade 2 and 3 patients with grade 1.However,3D T1-SPACE demonstrated that all 25 patients were grade 4.The 3D T1-SPACE was superior to evaluate the in-stent lumens than 3D-TOF MRA(Z=-4.484,P<0.001).Taking DSA as standard,the specificity and accuracy of the aneurysm remnants evaluated by 3D-TOF MRA were 86.9%(20/23)and 84.0%(21/25),respectively.Conclusion 3.0 T 3D T1-SPACE MR sequence can be used to assess parent artery patency,with in-stent lumen being clearly visible.3D-TOF MRA can evaluate intracranial aneurysm remnants.The combination of these two MRI imaging techniques can be used as an optional follow-up evaluation after the endovascular treatment of intracranial aneurysms.