高分辨率磁共振血管造影单动脉突出技术评估颅内动脉瘤：与数字减影血管造影的相关性。
Evaluation of intracranial aneurysms with high-resolution MR angiography using single-artery highlighting technique: correlation with digital subtraction angiography.
机构信息
Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
出版信息
Radiol Med. 2013 Dec;118(8):1379-87. doi: 10.1007/s11547-012-0871-1. Epub 2012 Aug 9.
PURPOSE
The authors investigated the effectiveness of high-resolution magnetic resonance angiography (MRA) using a single-artery highlighting technique for the accurate diagnosis of intracranial aneurysms at 3.0 T in a large cohort of patients with suspected intracranial aneurysms against the current gold standard, i.e. cerebral angiography.
METHODS
A total of 307 patients with suspected aneurysms were referred for three-dimensional time-of-flight MRA (3D-TOF-MRA) prior to digital subtraction angiography (DSA). We summarised patient-based, aneurysm-based and vessel-based diagnostic performance parameters, namely, accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting intracranial aneurysms with 3D-TOF-MRA. Interobserver agreement was calculated with the kappa (κ) statistic.
RESULTS
Patient-based accuracy was 98.1%, sensitivity 99.5%, specificity 95.3%, PPV 97.6% and NPV 99% according to observer A; and 97.7%, 99.5%, 94.3%, 97.1% and 99%, respectively, according to observer B. Aneurysmbased accuracy was 98.3%, sensitivity 99.6%, specificity 95.2%, PPV 98.1% and NPV 99% according to observer A, and 98.0%, 99.6%, 94.3%, 97.7% and 99%, respectively, according to observer B. Vessel-based accuracy was 99.0%, sensitivity 99.6%, specificity 98.7%, PPV 97.8%, and NPV 99.7% according to observer A, and 98.9%, 99.6%, 98.5%, 97.3%, and 99.7%, respectively, according to observer B. Interobserver reading differences were not significant. The interobserver agreement was good, with a kappa (κ) value of 0.931 for patient-based evaluation, 0.934 for aneurysmbased evaluation and 0.953 for vessel-based evaluation.
CONCLUSIONS
Our results demonstrate the effectiveness of high-resolution MRA using a single-artery-highlighting technique for accurate diagnosis of intracranial aneurysms in a large cohort of patients with suspected aneurysms.
目的
作者研究了在疑似颅内动脉瘤的大患者队列中，使用单动脉突出技术的高分辨率磁共振血管造影（MRA）对颅内动脉瘤进行准确诊断的效果，该技术与当前的金标准即数字减影血管造影（DSA）相比。
方法
共 307 例疑似动脉瘤患者在数字减影血管造影（DSA）前进行三维时间飞跃磁共振血管造影（3D-TOF-MRA）。我们总结了基于患者、基于动脉瘤和基于血管的诊断性能参数，即使用 3D-TOF-MRA 检测颅内动脉瘤的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。观察者间的一致性用 Kappa（κ）统计进行计算。
结果
根据观察者 A，基于患者的准确率为 98.1%，敏感性为 99.5%，特异性为 95.3%，阳性预测值（PPV）为 97.6%，阴性预测值（NPV）为 99%；根据观察者 B，准确率为 97.7%，敏感性为 99.5%，特异性为 94.3%，阳性预测值（PPV）为 97.1%，阴性预测值（NPV）为 99%。根据观察者 A，基于动脉瘤的准确率为 98.3%，敏感性为 99.6%，特异性为 95.2%，阳性预测值（PPV）为 98.1%，阴性预测值（NPV）为 99%；根据观察者 B，准确率为 98.0%，敏感性为 99.6%，特异性为 94.3%，阳性预测值（PPV）为 97.7%，阴性预测值（NPV）为 99%。根据观察者 A，基于血管的准确率为 99.0%，敏感性为 99.6%，特异性为 98.7%，阳性预测值（PPV）为 97.8%，阴性预测值（NPV）为 99.7%；根据观察者 B，准确率为 98.9%，敏感性为 99.6%，特异性为 98.5%，阳性预测值（PPV）为 97.3%，阴性预测值（NPV）为 99.7%。观察者之间的阅读差异并不显著。观察者间的一致性良好，基于患者的评估 Kappa（κ）值为 0.931，基于动脉瘤的评估 Kappa（κ）值为 0.934，基于血管的评估 Kappa（κ）值为 0.953。
结论
我们的研究结果表明，在疑似动脉瘤的大患者队列中，使用单动脉突出技术的高分辨率 MRA 可准确诊断颅内动脉瘤。
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