Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea.
Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
J Neuroimaging. 2021 May;31(3):532-540. doi: 10.1111/jon.12846. Epub 2021 Apr 13.
We aimed to assess the accuracy of magnetic resonance angiography (MRA) in the differentiation of small aneurysms versus infundibular dilations (IDs) at the internal carotid artery-posterior communicating artery (ICA-PComA) junction, emphasizing the role of MRA axial source images.
This retrospective study consisted of 83 focal arterial protrusions at ICA-PComA junction in 76 patients who underwent both MRA and digital subtraction angiography (DSA)/3-dimensional rotational angiography (3DRA). The diagnostic performance of MRA for differential diagnosis of aneurysm from ID was calculated using DSA/3DRA interpretation as the standard of reference. In addition, long-axis diameter, short-axis diameter, long-axis diameter/short-axis diameter (L/S) ratio, and angle of lesion (angle of the long-axis of lesion with respect to the x-axis) measured on MRA source images were compared between aneurysms and IDs.
Sensitivity, specificity, and accuracy of MRA for distinguishing aneurysms from IDs were 74.4% (57.9-87.0%) to 76.9% (60.7-88.9%), 93.2% (81.3-98.6%) to 95.5% (84.5-99.4%), and 85.5% (76.1-92.3%), respectively. Significant differences were found for the long-axis diameter (P < .001), short-axis diameter (P < .001), L/S ratio (P < .05), and angle of the lesion (P < .001) on MRA axial source images between aneurysms and IDs. The angle of the lesion had the highest discriminatory ability (area under the curve = .966 [.902-.994]) to differentiate aneurysms from IDs. An angle of lesion >60° was 89.7% (75.8-97.1%) sensitive and 100% (92.0-100.0%) specific for diagnosis of aneurysm.
MRA is a useful imaging modality for distinguishing between aneurysm and ID at the ICA-PComA junction. Furthermore, geometric parameters on MRA axial source images can provide added value in their differentiation.
我们旨在评估磁共振血管造影（MRA）在颈内动脉-后交通动脉（ICA-PComA）交界处区分小动脉瘤与漏斗扩张（IDs）的准确性，重点强调 MRA 轴位源图像的作用。
本回顾性研究纳入了 76 例患者的 83 个 ICA-PComA 交界处局灶性动脉突起，这些患者均接受了 MRA 和数字减影血管造影（DSA）/三维旋转血管造影（3DRA）检查。使用 DSA/3DRA 解读作为参考标准，计算 MRA 对动脉瘤与 IDs 进行鉴别诊断的诊断性能。此外，还比较了 MRA 源图像上测量的动脉瘤与 IDs 的长轴直径、短轴直径、长轴直径/短轴直径（L/S）比值和病变角度（病变长轴与 x 轴的夹角）。
MRA 区分动脉瘤与 IDs 的敏感性、特异性和准确性分别为 74.4%（57.9%-87.0%）至 76.9%（60.7%-88.9%）、93.2%（81.3%-98.6%）至 95.5%（84.5%-99.4%）和 85.5%（76.1%-92.3%）。在 MRA 轴位源图像上，动脉瘤与 IDs 之间的长轴直径（P<.001）、短轴直径（P<.001）、L/S 比值（P<.05）和病变角度（P<.001）存在显著差异。病变角度具有最高的鉴别能力（曲线下面积为.966[.902-.994]），可区分动脉瘤与 IDs。病变角度>60°时，对诊断动脉瘤的敏感性为 89.7%（75.8%-97.1%），特异性为 100%（92.0%-100.0%）。
MRA 是区分 ICA-PComA 交界处动脉瘤与 IDs 的有用成像方式。此外，MRA 轴位源图像上的几何参数可为两者的鉴别提供附加价值。
