3.0T磁共振3D T1黑血序列对颈部动脉夹层诊断的研究

发布时间：2018-03-17 16:44

本文选题：颈部动脉夹层　切入点：3D　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的:颈部动脉夹层(cervical artery dissection,CAD)是青年缺血性脑卒中的重要病因,在45岁以下缺血性脑卒中患者中高达8-25%。缺血性脑卒中也是CAD最常见的并发症,常发生于CAD发病的最初几天内。因此,早期、准确的诊断有助于CAD患者选择更合适的治疗方式以预防卒中的发生和复发。作为3D(three-dimensional,3D)T1黑血序列的一种,既往研究已经初步证实3D T1 VISTA序列(3D T1-weighted sequence of volumetric isotropic turbo spin echo acquisition,3D T1 VISTA序列)在1.5T磁共振上有助于CAD的诊断。本研究旨在分析在3.0T磁共振上3D T1VISTA序列对CAD的诊断价值,同时探讨其局限性。方法:本研究连续性、前瞻性纳入发病一个月内、临床怀疑CAD的患者。所有患者都接受了3.0T磁共振3D T1 VISTA检查,同时至少完成颈部磁共振血管成像(magnetic resonance angiography,MRA)、计算机断层扫描血管造影(computed tomography angiography,CTA)和数字减影血管造影(digital subtraction angiography,DSA)其中一种检查。所有患者的影像检查结果分别由两个经验丰富并且不了解患者病史和最终诊断的神经影像学医生进行评价。对于CAD的诊断,3D T1 VISTA序列的诊断标准为壁间血肿、内膜片、双腔征和动脉瘤样扩张;颈部MRA、CTA和DSA的诊断标准为内膜片、双腔征、串珠征、线样征和锥形闭塞;颈部动脉超声的诊断标准为内膜片、双腔征、壁间血肿和非动脉粥样硬化常见部位(颈动脉窦2cm以上的颈内动脉和椎动脉V2-V4段)的狭窄或闭塞。CAD的最终诊断基于病史、临床表现和所有影像学检查结果。用SPSS 19.0统计软件(SPSS,IBM,West Grove,PA,USA)对数据进行统计学分析。由于目前尚无CAD诊断的单一金标准,以最终诊断作为参考标准,分别计算3D T1VISTA序列对CAD诊断的敏感性和特异性(包括95%的可信区间)。3D T1VISTA序列的观察者之间一致性和3D T1 VISTA序列和DSA/颈部动脉超声检查对CAD诊断的一致性用κ值表示。用Fisher确切概率法比较两组计数资料的差异,双侧p0.05认为差异具有统计学意义。结果:本研究总共纳入了46例患者,所有患者都接受了3D T1 VISTA序列和颈部动脉超声检查,其中有25例患者接受了3D T1 VISTA序列和DSA检查。最终诊断为CAD的患者有21例,根据3D T1 VISTA序列的检查结果,其中20例CAD患者得以诊断。因此,3D T1 VISTA序列对CAD诊断的敏感性和特异性分别为95.2%(95%的可信区间,76.2%-99.9%)和100%(95%的可信区间,86.3%-100%)。两位神经影像学医生对3D T1 VISTA序列的观察一致性非常好(κ=0.91)。3D T1 VISTA序列和DSA检查对CAD诊断有非常好的一致性(κ=0.92);3D T1 VISTA序列和颈部动脉超声检查对CAD诊断的一致性中等(κ=0.56)。3D T1 VISTA序列对29例没有颈部动脉闭塞的患者都能明确诊断有无夹层,但是对于17例存在颈部动脉闭塞的患者,有6例患者不能明确是否为动脉夹层(p=0.001)。结论:本研究发现3.0T磁共振3D T1 VISTA序列对CAD诊断有非常好的诊断价值。但是对部分存在动脉闭塞又缺少典型CAD影像特点的患者,3D T1 VISTA序列难以明确区分高信号病变是壁间血肿还是管腔内血栓。因此,这需要进一步的研究,可能3D T1 VISTA的随访影像、对比增强序列或序列优化等有帮助。
[Abstract]:Background and objective: cervical artery dissection (cervical artery dissection, CAD) is an important cause of ischemic stroke in youth, at the age of 45 patients with ischemic stroke in ischemic stroke is as high as 8-25%. the most common complications of CAD, the first few days often occurs in the pathogenesis of CAD. Therefore, there are early occurrence and recurrence help CAD patients to choose more appropriate treatment to prevent stroke diagnosis. As 3D (three-dimensional, 3D) a T1 black blood sequence, previous studies have confirmed that 3D T1 VISTA (3D T1-weighted sequence of volumetric sequence isotropic turbo spin echo acquisition 3D T1 VISTA sequence) is helpful to the diagnosis of CAD in the 1.5T magnetic resonance. This study aims to analyze the diagnostic value of 3D T1VISTA sequence of CAD in 3.0T magnetic resonance, and discuss its limitations. Methods: This study prospectively evaluated the incidence of continuity. Within a month, patients with clinical suspicion of CAD. All patients underwent 3.0T 3D T1 VISTA magnetic resonance examination, at least complete cervical magnetic resonance angiography (magnetic resonance angiography, MRA), computed tomography angiography (computed tomography angiography, CTA) and digital subtraction angiography (digital subtraction angiography, DSA) which a check. All imaging results were respectively by two experienced and do not understand the neuroimaging and final diagnosis in patients with a history of doctor evaluation. For the diagnosis of CAD 3D T1 VISTA sequence of the diagnostic criteria of intramural hematoma, intimal flap, double lumen sign and aneurysm neck; MRA diagnostic criteria of CTA and DSA for the film, double lumen sign, beaded sign, line like sign and tapered occlusion; carotid artery ultrasound diagnostic criteria for intimal flap, double lumen sign, intramural hematoma and non artery The common sites of atherosclerosis (carotid sinus 2cm above the internal carotid artery and vertebral artery V2-V4 segment) of.CAD stenosis or occlusion of the final diagnosis based on history, clinical manifestations and examination results of all imaging. Using SPSS 19 statistical software (SPSS, IBM, West, Grove, PA, USA). The data were analyzed by a single there is no gold standard for the diagnosis of CAD, with the final diagnosis as the reference standard, calculated the sensitivity and specificity of 3D T1VISTA sequence in the diagnosis of CAD (including 95% confidence interval) between.3D T1VISTA sequence observer consistency and 3D T1 VISTA sequence and DSA/ of carotid artery ultrasonography on diagnosis of CAD with kappa consistency the difference in value. Fisher's exact test were compared between the two groups of count data, P0.05 were considered statistically significant difference. Results: the study included 46 patients, all patients underwent 3D T1 VISTA sequence And neck artery ultrasound examination, of which 25 cases were treated with 3D T1 VISTA sequence and DSA examination. The final diagnosis of CAD patients with 21 cases, according to the 3D T1 VISTA sequence inspection results, including 20 cases of CAD patients can be diagnosed. Therefore, the sensitivity and specificity of 3D T1 VISTA sequence in the diagnosis of CAD respectively. 95.2% (95% Ci, 76.2%-99.9%) and 100% (95% Ci, 86.3%-100%). Two neuroimaging doctors observed on 3D T1 VISTA sequence is a very good consistency (kappa =0.91).3D T1 VISTA sequence and DSA examination is a very good for the diagnosis of CAD 3D (K =0.92); the T1 VISTA sequence and neck artery ultrasound in the diagnosis of CAD medium consistency (kappa =0.56).3D T1 VISTA sequence without neck artery occlusion in 29 patients were diagnosed with or without dissection, but for the existence of 17 cases of carotid artery occlusion in patients, 6 patients is not clear Whether the artery dissection (p=0.001). Conclusion: This study found that 3.0T 3D T1 VISTA magnetic resonance sequence has very good diagnostic value for the diagnosis of CAD. But on the part of the existence of arterial occlusion and lack of typical imaging features of CAD patients, 3D T1 VISTA sequence to make a clear distinction between high signal lesions is intramural hematoma or intraluminal thrombus. Therefore, the need for further research, 3D T1 VISTA may follow up imaging, contrast enhancement sequence or sequence optimization for help.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R445.2

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