SWI、DWI及Time-SLIP技术早期评估颈动脉斑块易损性临床应用研究

发布时间：2018-03-16 18:34

本文选题：颈动脉　切入点：磁共振血管成像　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的评估Time-SLIP血管成像的成像质量,评价Time-SLIP、CE-MRA以及DSA在颈动脉狭窄度评估方面的差异。资料与方法1.35例具有颈动脉斑块的患者先后使用磁共振进行Ti me-SLI P和CE-MRA扫描,其中1 0例患者3天后进一步行颈动脉DS A检查。2.在获取Ti me-SLI P和CE-MRA颈动脉血管图像后分别由两位副高级影像诊断医师对每幅图像质量、组织污染情况进行技术评分。3.并对Time-SLIP、CE-MRA显示的血管数量进行评价。4.对其中进行过DS A检查的1 0例患者,以NASCET法计算上述三种方法显示的颈动脉血管狭窄率。结果1.两位诊断医师对图像质量、组织污染及血管数量评价的一致性较高,Kappa值均0.80。2.35例患者,Time-SLIP组和CE-MRA组中,图像质量为3分以上者分别占94.2%、97.1%,差异无统计学意义(P0.05)。3.组织污染评分小于等于1分者分别占88.6%、82.9%,差异无统计学意义(P0.05)。4.双侧颈总动脉及主要分支总共210条血管,Time-SLIP和CE-MRA分别显示两侧颈总动脉、颈内动脉及颈外动脉血管数为199/210条和202/210条,其符合率分别为94.8%和96.2%,差异无统计学意义(P0.05)。5.其中10例患者,以DS A诊断为金标准,颈动脉狭窄Ti me-SLI P诊断的敏感性92.31%,特异性97.87%,准确性96.67%;CE-MRA诊断的敏感性100%,特异性97.87%,准确性98.33%;以DSA为标准两者显示狭窄的血管数为47/60、46/60,两者差异无统计学意义(P0.05)。结论1.Time-SLIP与CE-MRA在图像质量、组织污染、显示血管数量上具有较高的一致性。2.Time-SLIP用于颈动脉狭窄评估有较高的准确度。3.由于Ti me-SLI P技术无需对比剂的优势,能够廉价、无创的提示管腔狭窄程度,因此其对于临床有较高的应用前景。目的对比磁共振常规检查技术(T1WI、T2WI、PDWI)、磁敏感加权成像(SWI)、弥散加权成像(DWI)的图像质量。评价磁敏感加权成像、弥散加权成像在颈动脉斑块出血、早期炎症方面的应用价值。资料与方法1.40例经超声诊断有颈动脉斑块的患者先后使用磁共振进行磁共振常规检查技术(T1WI、T2WI、PDWI)和磁敏感加权成像(SWI)、弥散加权成像(DWI)的轴位扫描。2.5种序列图像分别由两位副高级医师对每幅图像质量情况进行技术评分,对具有诊断价值的图像进行评估。3.判断有无颈动脉斑块出血或早期炎症。结果1.40例患者中,其中T1WI、T2WI、PDWI、SWI、DWI组中,图像质量为3分以上者分别占90.0%、91.3%、92.5%、87.5%、88.8%,5个序列均具有诊断价值的有35例患者,两位诊断医师的一致性较高,Kappa值均0.80,5种方法的图像质量差异无统计学意义(P0.05)。2.磁共振常规检查技术及SWI、DWI分别诊断斑块出血例数分别为8、17、9例,三种检查技术相互比较,SWI与磁共振常规序列及DWI检测斑块出血之间差异具有统计学意义。磁共振常规检查技术及DWI分别诊断斑块炎症例数分别为4、11例,两种检查技术相互比较,DWI与磁共振常规序列检测斑块早期炎症之间差异具有统计学意义。结论1.SWI显示颈动脉斑块出血优于常规序列和DWI,DWI与常规序列基本一致。2.DWI显示颈动脉斑块早期炎症优于磁共振常规检查序列。3.三种序列结合,能够更好的发现颈动脉斑块出血及早期炎症情况,判断斑块易损性,预警脑卒中。
[Abstract]:Objective to evaluate the imaging quality evaluation, Time-SLIP angiography, Time-SLIP, CE-MRA and DSA in different degree of carotid stenosis assessment. Materials and methods 1.35 cases of patients with carotid artery plaque has the use of magnetic resonance Ti me-SLI P and CE-MRA scanning, including 10 cases of patients with carotid artery 3 days after further DS A examination.2. in access Ti me-SLI and P CE-MRA respectively after carotid artery vascular images by two deputy senior radiologist on each image quality, organization pollution technical score and.3. of Time-SLIP, the number of vascular CE-MRA showed 10 cases of DS evaluation of.4. A examination on the patients with carotid artery by the method of NASCET calculation shows the above three methods. Results 1. stenosis rate of two physicians on the image quality, the number of organizations and pollution evaluation of vascular high consistency, the Kappa values were 0.80.2.35 patients, Time-SLIP Group and CE-MRA group, the image quality for more than 3 points were respectively 94.2%, 97.1%, the difference was not statistically significant (P0.05).3. pollution score less than equal to 1 points accounted for 88.6%, 82.9%, the difference was not statistically significant (P0.05.4.) bilateral common carotid artery and branches a total of 210 vessels, Time-SLIP and CE-MRA respectively on both sides of the common carotid artery, external carotid artery and internal carotid artery blood vessel number of neck for 199/210 and 202/210, and the coincidence rate were 94.8% and 96.2%, the difference was not statistically significant (P0.05.5.) in 10 patients with DS, A diagnosis as the gold standard, Ti me-SLI P in the diagnosis of carotid artery stenosis and the sensitivity was 92.31%, specificity 97.87%, the accuracy was 96.67%; the sensitivity of 100% CE-MRA diagnosis, specificity of 97.87%, accuracy of 98.33%; with DSA as the standard two shows the number of vascular stenosis was 47/60,46/60, the difference was not statistically significant (P0.05). Conclusion 1.Time-SLIP and CE-MRA in image The quality of the organization, pollution, show that the consistency of.2.Time-SLIP has higher accuracy for the number of blood vessels on the.3. have a higher evaluation of carotid artery stenosis due to Ti me-SLI P without contrast agent advantage, to cheap, no stenosis of a prompt, so it has high application prospect in clinical. Objective to compare MRI check technology (T1WI, T2WI, PDWI), susceptibility weighted imaging (SWI), diffusion weighted imaging (DWI). The image quality evaluation of susceptibility weighted imaging, diffusion weighted imaging in carotid artery plaque hemorrhage, application value of early inflammation. Materials and methods 1.40 cases of ultrasound diagnosis of patients with carotid artery plaque has the use of magnetic resonance MRI routine examination (T1WI, T2WI, PDWI Technology) and susceptibility weighted imaging (SWI), diffusion weighted imaging (DWI) axial scan.2.5 sequences respectively by two associate senior doctor Technical score of each image quality evaluation,.3. to determine the presence of carotid plaque hemorrhage or early inflammation of the image has a high diagnostic value. Results in 1.40 patients, including T1WI, T2WI, PDWI, SWI, DWI group, the image quality was more than 3 points were respectively 90%, 91.3%, 92.5%. 87.5%, 88.8%, 5 series have diagnostic value in 35 patients and two physicians of the high consistency, no statistically significant differences in image quality Kappa value method 0.80,5 (P0.05).2. MRI examination technique and SWI, DWI respectively in diagnosis of plaque hemorrhage cases were 8,17,9 cases, three inspection technology comparison, with statistical significance SWI and MRI conventional sequences and DWI detection of plaque hemorrhage differences. Routine MRI examination and diagnosis were DWI plaque inflammation cases were 4,11 cases, two kinds of inspection techniques are compared with each other, and magnetic DWI There was statistically significant difference between the conventional resonance sequence detection of plaque inflammation. Conclusion early 1.SWI showed carotid artery plaque hemorrhage is superior to the conventional sequence and DWI sequence, DWI and conventional.2.DWI display consistent carotid plaque inflammation is better than that of routine MRI examination in early three with the sequence of.3. sequence, and better able to find early inflammation of carotid plaque hemorrhage judgment, plaque vulnerability, warning stroke.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.4;R445.2

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