[斜矢状面黑血对比增强磁共振成像在颈动脉内膜切除术术前评估中的应用]

[Oblique-sagittal black-blood contrast-enhanced magnetic resonance imaging in preoperative evaluation for carotid endarterectomy].

作者信息

WANG Qing-jun, WANG Yong, CAI Jian-ming, ZHAO Ting-qiang, MA Lin, CAI You-quan, CHEN Li-feng, WANG Zhan-bo

机构信息

Department of Radiology, General Hospital of PLA, Beijing 100853, China.

出版信息

Nan Fang Yi Ke Da Xue Xue Bao. 2011 Mar;31(3):385-91.

PMID:21421468

Abstract

OBJECTIVE

To evaluate the value of oblique-sagittal black-blood contrast-enhanced magnetic resonance imaging (OB-CEMRI) in atherosclerotic carotid artery (CA) assessment before carotid endarterectomy (CEA).

METHODS

Twenty-five patients with symptomatic atherosclerotic stenosis in the carotid artery (involving 26 arteries) were scheduled for CEA. OB-CEMRI and digital subtraction angiography (DSA) were conducted within 1 week prior to CEA, and two radiologists independently assessed the location of maximal lumen stenosis, plaque rupture, degree of maximal lumen stenosis and plaque involvement on DSA and OB-CEMRI images. The differences of DSA and the OB-CEMRI in analyzing the plaque conditions were assessed in comparison with matched histological sections of the excised specimens.

RESULTS

Compared with the corresponding histological specimens, both DSA (κ=0.807) and OB-CEMRI (κ=0.812) showed a good consistency in defining the location of the maximal lumen stenosis. OB-CEMRI showed a better performance in detecting plaque rupture with higher sensitivity (90.0%) and specificity (83.3%) than DSA (40.0% and 66.7%, respectively). No significant difference was found between DSA and the OB-CEMRI in evaluating the degree of maximal lumen stenosis [(77.33∓3.79)% vs (76.02∓3.95)%, P=0.648]. Compared with the histological examination, OB-CEMRI appeared to underestimate the stenosis. The plaque extent on OB-CEMRI was larger than that on DSA (18.96∓4.96 mm vs 14.80∓3.78 mm, P=0.004), and similar to that by histological examination (18.13∓4.57 mm, P=0.506).

CONCLUSIONS

OB-CEMRI allows noninvasive and objective detection of the location of the maximal lumen stenosis, plaque rupture, and plaque extent, though with a lower accuracy than DSA in the assessment of the maximal lumen stenosis. OB-CEMRI combined with DSA offers a more reliable means for preoperative evaluation of the carotid artery plaques for CEA.

摘要

目的

评估斜矢状位黑血对比增强磁共振成像（OB-CEMRI）在颈动脉内膜切除术（CEA）前对动脉粥样硬化性颈动脉（CA）评估中的价值。

方法

25例有症状的颈动脉粥样硬化狭窄患者（累及26条动脉）计划行CEA。在CEA前1周内进行OB-CEMRI和数字减影血管造影（DSA），两名放射科医生独立评估DSA和OB-CEMRI图像上最大管腔狭窄的位置、斑块破裂、最大管腔狭窄程度及斑块累及情况。将DSA和OB-CEMRI在分析斑块情况方面的差异与切除标本的匹配组织学切片进行比较评估。

结果

与相应的组织学标本相比，DSA（κ=0.807）和OB-CEMRI（κ=0.812）在确定最大管腔狭窄位置方面均表现出良好的一致性。OB-CEMRI在检测斑块破裂方面表现更好，其敏感性（90.0%）和特异性（83.3%）均高于DSA（分别为40.0%和66.7%）。在评估最大管腔狭窄程度方面，DSA与OB-CEMRI之间未发现显著差异[（77.33±3.79）%对（76.02±3.95）%，P=0.648]。与组织学检查相比，OB-CEMRI似乎低估了狭窄程度。OB-CEMRI上的斑块范围大于DSA上的斑块范围（18.96±4.96 mm对14.80±3.78 mm，P=0.004），且与组织学检查的结果相似（18.13±4.57 mm，P=0.506）。