三维对比剂增强MR血管成像对颈部动脉病变的诊断价值

目的　分析三维对比剂增强MR血管成像 (3DCE MRA)显示的颈部动脉常见病变 ;与DSA比较 ,明确 3DCE MRA诊断颈部动脉病变的价值。方法　对 741例超声多普勒怀疑颈部动脉疾病的患者进行 3DCE MRA成像 ,并根据其病变表现总结分类。 2 0 6例病人同时行DSA检查 ,将颈部动脉分为颈总、颈内、颈外、锁骨下及椎动脉 5个部位 ,由 2位放射学专家独立评估DSA及 3DCE MRA血管资料。结果　 3 6 7%病例 (2 72 / 741)显示无异常。 63 2 9% (469/ 741)显示颈部动脉有病变 ,共计 82 7段 ,其中动脉粥样斑块占 3 4 2 2 % (2 83段 ) ,动脉狭窄占 3 4 46% (2 85段 ) ,动脉闭塞占 3 3 8% (2 8段 ) ,动脉发育纤细占 14 87% (12 3段 ) ;动脉开口变异占 3 87% (3 2段 ) ,动脉扭曲占 3 63 % (3 0段 ) ,动脉瘤占 0 72 % (6段 ) ,动脉夹层占 1 2 1% (10段 ) ,肿瘤包绕或推压动脉占 1 45% (12段 ) ,术后复查占2 18% (18段 )。对 2 0 6例的 412段血管与DSA比较 ,3DCE MRA在颈总动脉、颈内动脉及椎动脉的阳性检出率差异有显著性意义 (P <0 0 1) ,主要是对动脉粥样斑块 (2 56段与 2 83段 )和动脉狭窄 (2 58段与 2 85段 )存在一定的高估。但对 412段血管整个样本 ,两种方法在同一部位诊断各种血管病变差异无显著性意义 (P >0 0

The diagnostic value of three-dimensional contrast-enhanced MR angiography in the arterial disease of the neck region

Objectives To analyze the d iseases of arteries on three-dimensional contrast-enhanced MR angiography (3D CE-MRA) and to demonstrate the diagnostic value for diseases of arteries in neck region by comparing with digital subtraction angiography (DSA) Methods 3D CE-MRA was performed in 741 patients with suspected disease of arteries by Doppler ultrasound (DUS) in neck region The diseases of arteries were classified according to findings on CE-MRA DSA was simultaneously performed in 206 patients All of arteries in neck region were artificially divided into five groups: common carotid arteries,internal carotid arteries,external carotid arteries,subclavian arteries,and vertebral arteries DSA and 3D CE-MRA findings were independently evaluated by two experienced radiologists Sensitivity,specificity,and accuracy of CE-MRA detection on plaques,stenosis,and occlusion of arteries in five groups were calculated and compared with those of DSA Results 36 7% (272/741) cases did not show any abnormalities on 3D CE-MRA 63 29% (469/741) cases totally showed 827 segments of abnormal arteries Of them,plaques of atherosclerosis accounted for 34 22% ( n =283),stenosis of arteries 34 46% ( n =285),occlusion of arteries 3 38% ( n =28),tenuous arteries 14 87% ( n =123),aberrant arteries 3 87% ( n =32),tortuous arteries 3 63% ( n =30),aneurysms 0 72% ( n =6),arterial dissections 1 21% ( n =10),arteries surrounded by tumor 1 45% ( n =12),and follow-up of vascular grafts 2 18% ( n =18) The rate of positive detection had significant statistic difference between DSA and 3D CE-MRA in 206 cases of common carotid arteries,internal carotid arteries,and vertebral arteries,mainly due to overestimation for evaluating the plaques (256 vs 283 segments) and stenosis (258 vs 285 segments) For the whole samples of 412 segments, there was no significant statistic difference between DSA and 3D CE-MRA in evaluating various artery diseases at the same sites The accuracy of 3D CE-MRA was 96 60% in common carotid arteries,96 36% in internal carotid arteries,98 54% in external carotid arteries,99 51% in subclavian arteries,and 93 93% in vertebral arteries,respectively The accuracy of detecting plaques,stenosis,and occlusion of arteries was 97 71%,97 62%,and 100%,respectively Conclusion 3D CE-MRA is a reliable noninvasive method for evaluating arteries in neck region and it can replace DSA for the purpose of diagnosis