基于三维自旋回波的黑血磁共振血管成像在蛛网膜下腔出血后血管痉挛检测中的应用。

Three-dimensional spin-echo-based black-blood MRA in the detection of vasospasm following subarachnoid hemorrhage.

机构信息

Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.

Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.

出版信息

J Magn Reson Imaging. 2019 Mar;49(3):800-807. doi: 10.1002/jmri.26231. Epub 2018 Oct 4.

DOI:10.1002/jmri.26231

PMID:30284331

Abstract

BACKGROUND

Black-blood MR angiography (BBMRA), which utilizes a non-T contrast spin-echo type technique, has been expected to overcome several issues associated with time-of-flight (TOF) MRA.

PURPOSE

To investigate the efficacy of BBMRA to detect vasospasms following subarachnoid hemorrhage (SAH).

STUDY TYPE

Retrospective.

SUBJECTS

Seventeen patients with SAH in their early posttreatment period.

FIELD STRENGTH/SEQUENCE: BBMRA, which uses a volumetric isotropic turbo spin-echo acquisition (VISTA), and TOF-MRA on 1.5T scanners.

ASSESSMENT

Visualization of supratentorial arteries and veins in BBMRA was rated on a 4-point scale by two neuroradiologists. Another neuroradiologist independently assessed TOF-MRA. The degree of the vasospasm was then evaluated using a 3-point scale by the same readers. The diagnostic performance of the MRAs was evaluated using computed tomography angiography (CTA) or digital subtraction angiography (DSA) as the standard of reference.

STATISTICAL TESTS

Wilcoxon signed rank test, McNemar test, and Cohen's kappa coefficient.

RESULTS

BBMRA provided superior visualization of the anterior and middle cerebral arteries than TOF-MRA (P < 0.05). The depiction of the veins was more pronounced on BBMRA (P < 0.01). Of the 166 arterial segments evaluated by CTA or DSA, 23 (13.9%) could not be assessed using TOF-MRA because of high signal hemorrhage, whereas BBMRA enabled visualization of all the segments. Vasospasm was confirmed in 30 segments by CTA or DSA. The sensitivity, specificity, and positive and negative predictive values were 73, 96, 76, and 95 for TOF-MRA and 91, 100, 100, and 98 for BBMRA, respectively (P = 0.13 for sensitivity, P = 0.06 for specificity). The agreement of the degree of vasospasm between MRA and the standard of reference, as indicated by kappa value, was 0.71 (95% confidence interval [CI], 0.55-0.87) for TOF-MRA and 0.91 (95% CI, 0.82-0.99) for BBMRA.

DATA CONCLUSION

BBMRA, owing to its contrast properties, may be superior to TOF-MRA for the evaluation of intracranial arteries after SAH.

LEVEL OF EVIDENCE

3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:800-807.

摘要

背景

利用非 T 对比自旋回波类型技术的黑血磁共振血管造影术（BBMRA）有望克服与时间飞跃（TOF）MRA 相关的多个问题。

目的

研究 BBMRA 检测蛛网膜下腔出血（SAH）后血管痉挛的效果。

研究类型

回顾性。

研究对象

17 例治疗早期的 SAH 患者。

磁场强度/序列：1.5T 扫描仪上使用容积各向同性涡轮自旋回波采集（VISTA）的 BBMRA 和 TOF-MRA。

评估

两位神经放射科医生对 BBMRA 中颅顶动脉和静脉的可视化情况进行了 4 分制评分。另一位神经放射科医生对 TOF-MRA 进行了独立评估。然后，同一读者使用 3 分制评估血管痉挛程度。MRAs 的诊断性能使用计算机断层血管造影（CTA）或数字减影血管造影（DSA）作为参考标准进行评估。

统计检验

Wilcoxon 符号秩检验、McNemar 检验和 Cohen's kappa 系数。

结果

BBMRA 对大脑前动脉和大脑中动脉的显示优于 TOF-MRA（P < 0.05）。BBMRA 对静脉的显示更明显（P < 0.01）。在 CTA 或 DSA 评估的 166 个动脉节段中，23 个（13.9%）由于高信号出血而无法使用 TOF-MRA 进行评估，而 BBMRA 则可以显示所有节段。30 个节段通过 CTA 或 DSA 确认存在血管痉挛。TOF-MRA 的灵敏度、特异性、阳性预测值和阴性预测值分别为 73%、96%、76%和 95%，BBMRA 分别为 91%、100%、100%和 98%（灵敏度 P = 0.13，特异性 P = 0.06）。MRA 与标准参考之间的血管痉挛程度的一致性，用 kappa 值表示，TOF-MRA 为 0.71（95%置信区间 [CI]，0.55-0.87），BBMRA 为 0.91（95%CI，0.82-0.99）。