Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands.
Radiology. 2010 Jul;256(1):209-18. doi: 10.1148/radiol.10091528. Epub 2010 May 26.
To determine the test characteristics of magnetic resonance (MR) angiography in the assessment of occlusion of aneurysms treated with coil placement.
This was an ethics committee-approved multicenter study. written informed consent was obtained in 311 patients with 343 aneurysms, who had been treated with coil placement and were scheduled for routine follow-up with intraarterial digital subtraction angiography (DSA). Thirty-five patients participated two or three times. Either 3.0- or 1.5-T time-of-flight (TOF) and contrast material-enhanced MR angiography were performed in addition to intraarterial DSA. Aneurysm occlusion was evaluated by independent readers at DSA and MR angiography. The test characteristics of MR angiography were assessed by using DSA as the standard. The area under the receiver operating characteristic curve (AUC) was calculated for 3.0- versus 1.5-T MR angiography and for TOF versus contrast-enhanced MR angiography, and factors associated with discrepancies between MR angiography and DSA were assessed with logistic regression.
Aneurysm assessments (n = 381) at DSA and MR angiography were compared. Incomplete occlusion was seen at DSA in 88 aneurysms (23%). Negative predictive value of MR angiography was 94% (95% confidence interval [CI]: 91%, 97%), positive predictive value was 69% (95% CI: 60%, 78%), sensitivity was 82% (95% CI: 72%, 89%), and specificity was 89% (95% CI: 85%, 93%). AUCs were similar for 3.0- (0.90 [95% CI: 0.86, 0.94]) and 1.5-T MR (0.87 [95% CI: 0.78, 0.95]) and for TOF MR (0.86 [95% CI: 0.81, 0.91]) versus contrast-enhanced MR (0.85 [95% CI: 0.80, 0.91]). A small residual lumen (odds ratio, 2.1 [95% CI: 1.1, 4.3]) and suboptimal projection at DSA (odds ratio, 5.5 [95% CI: 1.5, 21.0]) were independently associated with discordance between intraarterial DSA and MR angiography.
Documentation of good diagnostic performance of TOF MR angiography at both 1.5 and 3.0 T in the current study represents an important step toward replacing intraarterial DSA with MR angiography in the follow-up of patients with aneurysms treated with coils.
确定磁共振（MR）血管造影术在评估接受线圈放置治疗的动脉瘤闭塞中的检测特征。
本研究经伦理委员会批准，共纳入 311 例 343 个动脉瘤患者，这些患者均接受了线圈放置治疗，计划进行常规的数字减影血管造影（DSA）随访。35 例患者进行了 2 次或 3 次检查。所有患者均在进行 DSA 检查的同时，行 3.0-T 或 1.5-T 时间飞越（TOF）对比增强 MR 血管造影检查。由独立的读者在 DSA 和 MR 血管造影上评估动脉瘤的闭塞情况。采用 DSA 作为标准，评估 MR 血管造影的检测特性。计算 3.0-T 与 1.5-T MR 血管造影以及 TOF 与对比增强 MR 血管造影的受试者工作特征曲线下面积（AUC），采用逻辑回归分析评估与 MR 血管造影和 DSA 结果不一致的相关因素。
比较了 DSA 和 MR 血管造影上的动脉瘤评估结果（n=381）。88 个动脉瘤（23%）在 DSA 上显示不完全闭塞。MR 血管造影的阴性预测值为 94%（95%置信区间：91%，97%），阳性预测值为 69%（95%置信区间：60%，78%），灵敏度为 82%（95%置信区间：72%，89%），特异度为 89%（95%置信区间：85%，93%）。3.0-T（0.90[95%置信区间：0.86，0.94]）和 1.5-T MR（0.87[95%置信区间：0.78，0.95]）与 TOF MR（0.86[95%置信区间：0.81，0.91]）的 AUC 相似，与对比增强 MR（0.85[95%置信区间：0.80，0.91]）的 AUC 也相似。小的残余管腔（比值比，2.1[95%置信区间：1.1，4.3]）和 DSA 下的次优投照（比值比，5.5[95%置信区间：1.5，21.0]）是与 DSA 和 MR 血管造影结果不一致的独立相关因素。
本研究在 1.5-T 和 3.0-T 上均证明了 TOF MR 血管造影术的良好诊断性能，这是朝着用 MR 血管造影术替代动脉瘤线圈治疗患者的 DSA 随访迈出的重要一步。
