对比后磁敏感加权成像：一种用于检测脑动静脉畸形中动静脉分流的新技术。
Postcontrast susceptibility-weighted imaging: a novel technique for the detection of arteriovenous shunting in vascular malformations of the brain.
机构信息
Division of Neuroradiology, Washington University, St Louis, MO, USA.
出版信息
Stroke. 2011 Nov;42(11):3127-31. doi: 10.1161/STROKEAHA.111.623587. Epub 2011 Sep 22.
BACKGROUND AND PURPOSE
The purpose of this study was to determine the utility of postcontrast susceptibility-weighted MRI (PCSWI) in the evaluation of vascular malformations of the brain (BVM).
METHODS
We retrospectively evaluated PCSWI and digital subtraction angiography data from 16 consecutive patients with known or suspected BVM, which had been entered into a prospectively maintained database during a 1-year period. There had been no intervening treatment or change in patients' symptoms between the PCSWI and digital subtraction angiography studies. The use of PCSWI in the detection of arteriovenous shunting was compared with that of routine noncontrast susceptibility-weighted imaging, time-of-flight MR angiography, and contrast-enhanced MR angiography using digital subtraction angiography results as the reference standard. The presence of arteriovenous shunting in PCSWI or susceptibility-weighted imaging sequences was defined by the presence of abnormal signal hyperintensity in the venous structures adjacent to the BVM.
RESULTS
A total of 17 BVMs were identified by digital subtraction angiography (9 newly diagnosed arteriovenous malformations, 3 dural arteriovenous fistulas, 4 treated arteriovenous malformations with residual arteriovenous shunting, and 1 complex developmental venous anomaly). PCSWI was 100% sensitive and 100% specific with 100% positive predictive value and 100% negative predictive value for the detection of arteriovenous shunting in these BVMs. The PCSWI/susceptibility-weighted imaging signal intensity ratio in the most prominent early draining venous structure was 1.2±0.32.
CONCLUSIONS
PCSWI appears to be superior to susceptibility-weighted imaging, time-of-flight MR angiography, and contrast-enhanced MR angiography in detecting arteriovenous shunting in BVMs and may be useful in the initial diagnosis and follow-up of patients with BVMs.
背景与目的
本研究旨在评估对比增强磁敏感加权成像（PCSWI）在脑血管畸形（BVM）评估中的作用。
方法
我们回顾性评估了 16 例连续患者的 PCSWI 和数字减影血管造影（DSA）数据，这些患者在 1 年期间被纳入前瞻性维护的数据库中。在 PCSWI 和 DSA 研究之间，患者没有接受任何干预治疗或症状改变。使用 PCSWI 检测动静脉分流的效果与常规非对比磁敏感加权成像、时间飞跃磁共振血管造影（TOF-MRA）和对比增强磁共振血管造影（CE-MRA）进行比较，以 DSA 结果作为参考标准。PCSWI 或磁敏感加权成像序列中动静脉分流的存在定义为 BVM 附近静脉结构中异常信号高信号的存在。
结果
通过 DSA 共识别出 17 个 BVM（9 个新诊断的动静脉畸形、3 个硬脑膜动静脉瘘、4 个治疗后的动静脉畸形伴残留动静脉分流和 1 个复杂的发育性静脉异常）。PCSWI 对这些 BVM 中动静脉分流的检测具有 100%的敏感性和特异性，阳性预测值和阴性预测值均为 100%。最显著的早期引流静脉结构中 PCSWI/磁敏感加权成像信号强度比为 1.2±0.32。
结论
PCSWI 似乎优于磁敏感加权成像、TOF-MRA 和 CE-MRA，可用于检测 BVM 中的动静脉分流，可能有助于 BVM 患者的初始诊断和随访。
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