Anzalone Nicoletta, Scomazzoni Francesco, Castellano Renata, Strada Laura, Righi Claudio, Politi Letterio S, Kirchin Miles A, Chiesa Roberto, Scotti Giuseppe
Department of Neuroradiology, Scientific Institute, Ospedale San Raffaele, Milan 20132, Italy. anzalone@
Radiology. 2005 Jul;236(1):204-13. doi: 10.1148/radiol.2361032048. Epub 2005 Jun 13.
To compare three-dimensional (3D) time-of-flight (TOF) MR angiography, contrast-enhanced MR angiography, digital subtraction angiography (DSA), and rotational angiography for depiction of stenosis.
The study had Ethics Committee approval, and each patient gave written informed consent. Forty-nine patients (18 women, mean age, 67.2 years +/- 9.1 [+/- standard deviation], and 31 men, mean age, 63.1 years +/- 8.0) with symptomatic stenosis of internal carotid artery (ICA) diagnosed at duplex ultrasonography underwent transverse 3D TOF MR angiography with sliding interleaved kY acquisition and coronal contrast-enhanced MR angiography, followed by DSA and rotational angiography within 48 hours. MR angiography was performed at 1.5-T with a cervical coil. Contrast-enhanced MR angiograms were obtained after a bolus injection of 20 mL of gadobenate dimeglumine. Maximum ICA stenosis on maximum intensity projection and source images was quantified according to NASCET criteria. Correlations for 3D TOF MR angiography, contrast-enhanced MR angiography, DSA, and rotational angiography were determined by means of cross tabulation, and accuracy for detection and grading of stenoses were calculated. Data were evaluated with analysis of variance, Wilcoxon signed rank test, and McNemar test, all at significance of P < .05.
Ninety-eight ICAs were evaluated at contrast-enhanced MR angiography, DSA, and rotational angiography, and 97 were evaluated at 3D TOF MR angiography. Correlations for contrast-enhanced MR angiography, 3D TOF MR angiography, and DSA relative to rotational angiography were r2 = 0.9332, r2 = 0.9048, and r2 = 0.9255, respectively. Lower correlation (r2 = 0.8593) was noted for contrast-enhanced MR angiography and DSA. Respective sensitivity and specificity for detection of hemodynamically relevant stenosis relative to rotational angiography were 100% and 90% for contrast-enhanced MR angiography, 95.5% and 87.2% for 3D TOF MR angiography, and 88.6% and 100% for DSA. Four of 31 severe stenoses were underestimated at DSA, and three were underestimated at contrast-enhanced MR angiography. Three severe stenoses were underestimated at 3D TOF MR angiography, and one was misclassified as occluded. Of 13 moderate (50%-69%) stenoses, one was overestimated at contrast-enhanced MR angiography, two were underestimated and three overestimated at 3D TOF MR angiography, and two were underestimated at DSA.
DSA results in an underestimation of ICA stenosis compared with rotational angiography. Contrast-enhanced MR angiography correlates best with rotational angiography.
比较三维（3D）时间飞跃（TOF）磁共振血管造影、对比增强磁共振血管造影、数字减影血管造影（DSA）和旋转血管造影对狭窄的显示情况。
本研究经伦理委员会批准，每位患者均签署了书面知情同意书。49例经双功超声诊断为有症状的颈内动脉（ICA）狭窄患者（18例女性，平均年龄67.2岁±9.1[±标准差]，31例男性，平均年龄63.1岁±8.0）接受了采用滑动交错kY采集的横向3D TOF磁共振血管造影和冠状位对比增强磁共振血管造影，随后在48小时内进行DSA和旋转血管造影。磁共振血管造影在1.5-T使用颈部线圈进行。在静脉团注20 mL钆贝葡胺后获得对比增强磁共振血管造影片。根据北美症状性颈动脉内膜切除术（NASCET）标准对最大强度投影和源图像上的最大ICA狭窄进行量化。通过交叉列表确定3D TOF磁共振血管造影、对比增强磁共振血管造影、DSA和旋转血管造影之间的相关性，并计算狭窄检测和分级的准确性。采用方差分析、Wilcoxon符号秩检验和McNemar检验对数据进行评估，所有检验的显著性水平均为P <.05。
在对比增强磁共振血管造影、DSA和旋转血管造影中评估了98条ICA，在3D TOF磁共振血管造影中评估了97条ICA。对比增强磁共振血管造影、3D TOF磁共振血管造影和DSA相对于旋转血管造影的相关性分别为r2 = 0.9332、r2 = 0.9048和r2 = 0.9255。对比增强磁共振血管造影和DSA之间的相关性较低（r2 = 0.8593）。相对于旋转血管造影，对比增强磁共振血管造影检测血流动力学相关狭窄的敏感性和特异性分别为100%和90%，3D TOF磁共振血管造影为95.5%和87.2%，DSA为88.6%和100%。31例严重狭窄中有4例在DSA时被低估，3例在对比增强磁共振血管造影时被低估。3D TOF磁共振血管造影中有3例严重狭窄被低估，1例被误分类为闭塞。在13例中度（50%-69%）狭窄中，1例在对比增强磁共振血管造影时被高估，2例在3D TOF磁共振血管造影时被低估，3例被高估，2例在DSA时被低估。
与旋转血管造影相比，DSA会导致对ICA狭窄的低估。对比增强磁共振血管造影与旋转血管造影的相关性最佳。
