颈部无门控径向静止间期层选（QISS）磁共振血管成像：图像质量评估。
Ungated nonenhanced radial quiescent interval slice-selective (QISS) magnetic resonance angiography of the neck: Evaluation of image quality.
机构信息
Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.
University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
出版信息
J Magn Reson Imaging. 2019 Dec;50(6):1798-1807. doi: 10.1002/jmri.26781. Epub 2019 May 11.
BACKGROUND
Standard-of-care time-of-flight (TOF) techniques for nonenhanced magnetic resonance angiography (NEMRA) of the carotid bifurcation and other cervical arteries often provide nondiagnostic image quality due to motion and flow artifacts.
PURPOSE
To perform an initial evaluation of an ungated radial quiescent-interval slice-selective (QISS) technique for NEMRA of the neck, in comparison with 2D TOF and contrast-enhanced magnetic resonance angiography (CEMRA).
STUDY TYPE
Retrospective.
POPULATION
Sixty patients referred for neck MR angiography.
FIELD STRENGTH/SEQUENCE: Ungated radial QISS at 3T.
ASSESSMENT
Three radiologists scored image quality of 18 arterial segments using a 4-point scale (1, nondiagnostic; 2, fair; 3, good; 4, excellent), and two radiologists graded proximal internal carotid stenosis using five categories (<50%, 50-69%, 70-99%, occlusion, nondiagnostic).
STATISTICAL TESTS
Friedman tests with post-hoc Wilcoxon signed-rank tests; unweighted Gwet's AC1 statistic; tests for equality of proportions.
RESULTS
Ungated radial QISS provided image quality that significantly exceeded 2D TOF (mean scores of 2.7 vs. 2.0, 2.7 vs. 2.2, and 2.9 vs. 2.3; P < 0.001, all comparisons), while CEMRA provided the best image quality (mean scores of 3.6, 3.7, and 3.5 for the three reviewers). Interrater agreement of image quality scores was substantial for CEMRA (AC1 = 0.70, P < 0.001), and moderate for QISS (AC1 = 0.43, P < 0.001) and TOF (AC1 = 0.41, P < 0.001). Compared with TOF, QISS NEMRA provided a significantly higher percentage of diagnostic segments for all three reviewers (91.0% vs. 71.7%, 93.5% vs. 72.9%, 95.5% vs. 85.2%; P < 0.0001) and demonstrated better agreement with CEMRA for grading of proximal internal carotid stenosis (AC1 = 0.94 vs. 0.73 for reviewer 1, P < 0.05; AC1 = 0.89 vs. 0.68 for reviewer 2, P < 0.05).
DATA CONCLUSION
In this initial study, ungated radial QISS significantly outperformed 2D TOF for the evaluation of the neck arteries, with overall better image quality and more diagnostic arterial segments, and improved agreement with CEMRA for grading stenosis of the proximal internal carotid artery.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1798-1807.
背景
对于颈动脉分叉和其他颈部颈内动脉的非增强磁共振血管造影（NEMRA），标准护理时间飞跃（TOF）技术由于运动和血流伪影，往往提供诊断性差的图像质量。
目的
对非门控径向静止间期切片选择（QISS）技术在颈部 NEMRA 中的应用进行初步评估，并与 2D TOF 和对比增强磁共振血管造影（CEMRA）进行比较。
研究类型
回顾性
人群
60 例颈部磁共振血管造影检查的患者。
磁场强度/序列： 3T 无门控径向 QISS。
评估
3 位放射科医生使用 4 分制（1，无诊断性；2，尚可；3，好；4，优秀）对 18 个动脉段的图像质量进行评分，2 位放射科医生使用 5 个类别（<50%，50-69%，70-99%，闭塞，无诊断性）对近端颈内动脉狭窄进行分级。
统计检验
弗里德曼检验，事后检验采用 Wilcoxon 符号秩检验；未加权 Gwet's AC1 统计量；比例相等性检验。
结果
无门控径向 QISS 提供的图像质量明显优于 2D TOF（三位观察者的平均评分分别为 2.7 对 2.0、2.7 对 2.2 和 2.9 对 2.3；P<0.001，所有比较），而 CEMRA 提供了最佳的图像质量（三位观察者的平均评分分别为 3.6、3.7 和 3.5）。CEMRA 的图像质量评分的观察者间一致性较高（AC1=0.70，P<0.001），而 QISS（AC1=0.43，P<0.001）和 TOF（AC1=0.41，P<0.001）的一致性为中度。与 TOF 相比，QISS NEMRA 为三位观察者提供了更高比例的诊断性动脉段（91.0%对 71.7%、93.5%对 72.9%、95.5%对 85.2%；P<0.0001），并且与 CEMRA 相比，近端颈内动脉狭窄分级的一致性更好（观察者 1 的 AC1=0.94 对 0.73，P<0.05；观察者 2 的 AC1=0.89 对 0.68，P<0.05）。
数据结论
在这项初步研究中，无门控径向 QISS 在颈部动脉评估方面明显优于 2D TOF，具有整体更好的图像质量和更多的诊断性动脉段，并与 CEMRA 对近端颈内动脉狭窄的分级具有更好的一致性。
证据水平
3 技术功效：阶段 1 J. Magn. Reson. Imaging 2019；50：1798-1807.
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