磁共振血管成像在支架辅助弹簧圈栓塞颅内动脉瘤术后患者随访中的应用

发布时间：2018-05-28 13:51

本文选题：颅内动脉瘤 + 磁共振血管造影术　；参考：《中国脑血管病杂志》2017年07期

【摘要】：目的评价3.0 T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。方法回顾性连续纳入2013年6月至2015年6月深圳市第六人民医院神经外科因颅内动脉瘤破裂致蛛网膜下腔出血行支架辅助弹簧圈栓塞术患者32例,其中男12例,女20例,平均年龄(56±10)岁,术前均经DSA证实为单发颅内动脉瘤。于术后1~2年,对所有患者采用3.0 T时间飞跃法MRA(TOF-MRA)和对比剂增强法MRA(CE-MRA)进行影像学随访,以DSA结果为"金标准",对动脉瘤栓塞效果(稳定、进一步栓塞、再通/复发)及载瘤动脉的通畅性(无狭窄/轻度狭窄、中重度狭窄及闭塞)进行比较。结果 (1)TOF-MRA、CE-MRA及TOF-MRA结合源图像评估支架辅助弹簧圈栓塞术后动脉瘤效果与DSA的一致性比较,分别为一致性较差(Kappa=0.039,P=0.002)、一致性中等(Kappa=0.582,P0.01)、一致性较高(Kappa=0.615,P0.01)。(2)TOF-MRA及CE-MRA评估支架辅助弹簧圈栓塞术后载瘤动脉通畅性与DSA的一致性均较差(Kappa=0.171,P=0.211;Kappa=0.376,P=0.010)。(3)以DSA结果为参照,TOF-MRA、TOFMRA结合源图像和CE-MRA对动脉瘤栓塞情况判读的准确率分别为37.5%(12例)、75.0%(24例)和71.9%(23例),TOF-MRA分别与TOF-MRA结合源图像及CE-MRA比较,准确率的差异均有统计学意义(χ~2=9.04,P=0.003;χ~2=7.63,P=0.006);TOF-MRA结合源图像与CE-MRA的准确率差异无统计学意义(χ~2=0.08,P=0.777)。(4)以DSA结果为参照,TOF-MRA和CE-MRA对载瘤动脉通畅性判读的准确率分别为37.5%(12例)和62.5%(20例),准确率的差异无统计学意义(χ~2=4.67,P=0.097)。结论 3.0 T CE-MRA评估支架辅助弹簧圈栓塞术后颅内动脉瘤效果的准确率优于TOF-MRA,可作为随访的首选无创检查,TOF-MRA结合源图像与CE-MRA相当,但TOF-MRA及CE-MRA对评估载瘤动脉通畅性的准确性均较低。对于MRA检查阳性或不确定性结果,应进行个体化分析,必要时行DSA检查。
[Abstract]:Objective to evaluate the application of 3.0 T magnetic resonance angiography (MRAs) in the follow-up of intracranial aneurysm stent-assisted coils embolization. Methods from June 2013 to June 2015, 32 patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysms in neurosurgery department of Shenzhen sixth people's Hospital were treated with stent-assisted coils embolization, including 12 males and 20 females. The mean age was 56 卤10 years. All patients were confirmed as single intracranial aneurysms by DSA. From 1 to 2 years after operation, all patients were followed up with MRATOF-MRAand contrast enhancement method. The results of DSA were regarded as "gold standard", and the effect of embolization of aneurysms was stable and further embolized. The recanalization / recurrence of the artery and the patency of the aneurysm (no stenosis / mild stenosis, moderate or severe stenosis and occlusion) were compared. Results TOF-MRACE-MRA and TOF-MRA combined with source images were used to evaluate the consistency between stent-assisted coil embolization and DSA. The results of DSA were compared with TOF-MRA and CE-MRA to evaluate the patency of aneurysm carrying artery and the consistency of DSA after stent-assisted coils embolization. The results of DSA were compared with that of TOF-MRAF MRA combined with TOEF-MRA and CE-MRA on the basis of the results of TOF-MRAFMRA combined with TOEF-MRAFMRA and TOEF-MRAFMRA combined with TOEF-MRAFMRA as a reference to the results of TOF-MRA-TOFMRA combined with TOEF-MRAFMRA as a reference to the dynamic imaging and the contrast of CE-MRA with TOEF-MRAFMRA as the reference of TOF-MRAFMRA combined with TOEF-MRAFMRA and CE-MRA as the reference of TOF-MRAFMRA combined with source image and CE-MRA. The diagnostic accuracy of embolization was 37.5% in 12 cases and 75.0% in 24 cases. TOF-MRA was compared with TOF-MRA combined with source image and CE-MRA in 23 cases. The accuracy of TOF-MRA combined with CE-MRA had no statistical significance (蠂 ~ 2 / 29.04 / P 0.003; 蠂 ~ (27.63) / P ~ (0.006) combined with CE-MRA (蠂 ~ (2 / 2) 0.08 ~ (0.08) P ~ (0.777N). Compared with the results of DSA, the accuracy of TOF-MRA and CE-MRA in judging the patency of aneurysm carrying artery were 37.5% and 62.520 cases, respectively. The accuracy of TOF-MRA and CE-MRA were 37.5% and 62.520 cases respectively, and the accuracy of TOF-MRA and CE-MRA were 37.5% and 62.520 cases respectively. There was no statistical difference between the two groups (蠂 ~ (2 +) 4.67%, P = 0.097). Conclusion the accuracy of 3. 0T CE-MRA in evaluating intracranial aneurysms after stent assisted coils embolization is better than that of TOF-MRA. it can be used as the first choice of noninvasive examination for follow-up. The combination of TOF-MRA and source images is comparable to that of CE-MRA. However, the accuracy of TOF-MRA and CE-MRA in evaluating the patency of aneurysm carrier artery was low. For positive or uncertain results of MRA, individualized analysis should be performed, and DSA should be performed when necessary.
【作者单位】：深圳市第六人民医院神经外科;
【基金】：深圳市科技创新委员会项目(JCYJ 20140411092959835)
【分类号】：R651.12

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