颈动脉狭窄：对比增强磁共振血管造影诊断的准确性

Carotid artery stenosis: accuracy of contrast-enhanced MR angiography for diagnosis.

作者信息

Nederkoorn Paul J, Elgersma Otto E H, van der Graaf Yolanda, Eikelboom Bert C, Kappelle L Jaap, Mali Willem P T M

机构信息

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Rm E 01.132, 3508 GA Utrecht, The Netherlands.

出版信息

Radiology. 2003 Sep;228(3):677-82. doi: 10.1148/radiol.2283020824. Epub 2003 Jul 17.

DOI:10.1148/radiol.2283020824

PMID:12869686

Abstract

PURPOSE

To assess accuracy of contrast material-enhanced magnetic resonance (MR) angiography as compared with three-dimensional (3D) time-of-flight (TOF) MR angiography and reference digital subtraction angiography (DSA) in diagnosis of carotid artery stenosis.

MATERIALS AND METHODS

Enhanced and 3D TOF MR angiography and DSA were performed in 51 consecutive patients suspected of having carotid artery stenosis at duplex ultrasonography. Stenoses were measured by two independent observers blinded to clinical information and other test results. Pearson correlation coefficients were used, and kappa for interobserver variabilities was estimated. Sensitivity and specificity of enhanced and 3D TOF MR angiography were calculated and compared with those of DSA.

RESULTS

Pearson correlation coefficients were 0.94 (P <.01) for enhanced angiography versus DSA, 0.92 (P <.01) for 3D TOF angiography versus DSA, and 0.93 (P <.01) for enhanced versus 3D TOF angiography for observer 1 and 0.94 (P <.01), 0.95 (P <.01), and 0.94 (P <.01), respectively, for observer 2. kappa statistics were 0.81 for enhanced angiography, 0.79 for 3D TOF angiography, and 0.78 for DSA. Stenosis measurements of observer 1 at enhanced MR angiography, with inclusion of carotid arteries on the symptomatic side only, compared with those of DSA yielded a sensitivity of 90% (95% CI: 68%, 99%) and a specificity of 77% (95% CI: 55%, 92%). 3D TOF angiography yielded a sensitivity of 86% (95% CI: 67%, 97%) and a specificity of 73% (95% CI: 50%, 89%) compared with those of DSA. For observer 2, sensitivity and specificity for enhanced angiography were 91% (95% CI: 70%, 99%) and 76% (95% CI: 52%, 91%), respectively, and 90% (95% CI: 68%, 99%) and 77% (95% CI: 51%, 92%), respectively, for 3D TOF angiography.

CONCLUSION

Accuracy of enhanced MR angiography in diagnosis of severe stenosis is similar to that of 3D TOF MR angiography.

摘要

目的

评估对比剂增强磁共振（MR）血管造影与三维（3D）时间飞跃（TOF）MR血管造影及参考数字减影血管造影（DSA）在诊断颈动脉狭窄方面的准确性。

材料与方法

对51例经双功超声怀疑有颈动脉狭窄的连续患者进行增强及3D TOF MR血管造影和DSA检查。由两名对临床信息和其他检查结果不知情的独立观察者测量狭窄程度。采用Pearson相关系数，并估计观察者间变异性的kappa值。计算增强及3D TOF MR血管造影的敏感性和特异性，并与DSA的结果进行比较。

结果

观察者1的增强血管造影与DSA的Pearson相关系数为0·94（P <.01），3D TOF血管造影与DSA的为0·92（P <.01），增强血管造影与3D TOF血管造影的为0·93（P <.01）；观察者2的分别为0·94（P <.01）、0·95（P <.01）和0·94（P <.01）。增强血管造影的kappa统计值为0·81,3D TOF血管造影的为0·79，DSA的为0·78。观察者1仅纳入有症状侧颈动脉的增强MR血管造影狭窄测量结果与DSA相比，敏感性为90%（95%CI：68%，99%），特异性为77%（95%CI：55%，92%）。与DSA相比，3D TOF血管造影的敏感性为86%（95%CI：67%，97%），特异性为73%（95%CI：50%，89%）。观察者2的增强血管造影敏感性和特异性分别为91%（95%CI：70%，99%）和76%（95%CI：52%，91%），3D TOF血管造影的分别为90%（95%CI：68%，99%）和77%（95%CI：51%，92%）。