Cao Xin, Tang Ye, Pan Lei, Yang Jinming, Wu Yifan, Geng Daoying, Zhang Jun
Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
Quant Imaging Med Surg. 2021 Jun;11(6):2744-2755. doi: 10.21037/qims-20-869.
3D motion-sensitized driven-equilibrium prepared rapid gradient echo (MERGE) can characterize carotid atherosclerotic plaque morphology and composition. The present study aimed to evaluate its performance by comparing it with reference images and assessing the inter-reader agreement.
Eighty-four patients were prospectively recruited and scanned with 3D MERGE. Two trained magnetic resonance imaging (MRI) readers measured and calculated the maximum wall thickness (WT), maximum vessel diameter, total vessel area, lumen area, wall area, normalized wall index, plaque volume, intraplaque hemorrhage (IPH) volume, and calcification volume independently. IPH, calcification, mixed calcification, and ulceration were identified. The intraclass correlation coefficient (ICC) with 95% confidence interval (CI) was used to assess the inter-reader agreement. MERGE performance was assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, kappa value (κ), and the results of the Bland-Altman analysis and compared with reference images.
MERGE showed excellent inter-reader agreement (All ICCs >0.90). MERGE and simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) showed excellent agreement in detecting IPH (κ=0.938) and measuring IPH volume (ICC =0.995; 95% CI: 0.991-0.997). MERGE and computed tomography angiography (CTA) showed strong consistency in detecting calcification (κ=0.814) and mixed calcification (κ=0.972), and in measuring calcification volume (ICC =0.996; 95% CI: 0.993-0.997). MERGE and digital subtraction angiography (DSA) showed relatively strong consistency in identifying ulceration (κ=0.737).
MERGE showed excellent performance in identifying and measuring IPH and calcification in carotid atherosclerotic plaques. Therefore, MERGE can be a promising imaging approach in atherosclerotic-vulnerable plaque.
三维运动敏感驱动平衡准备快速梯度回波（MERGE）可对颈动脉粥样硬化斑块的形态和成分进行表征。本研究旨在通过与参考图像比较并评估阅片者间的一致性来评价其性能。
前瞻性招募84例患者并采用三维MERGE进行扫描。两名经过培训的磁共振成像（MRI）阅片者独立测量并计算最大管壁厚度（WT）、最大血管直径、血管总面积、管腔面积、管壁面积、标准化管壁指数、斑块体积、斑块内出血（IPH）体积和钙化体积。识别IPH、钙化、混合钙化和溃疡。采用具有95%置信区间（CI）的组内相关系数（ICC）来评估阅片者间的一致性。根据敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比、kappa值（κ）以及Bland-Altman分析结果评估MERGE的性能，并与参考图像进行比较。
MERGE显示出极好的阅片者间一致性（所有ICC均>0.90）。MERGE与同步非对比血管造影和斑块内出血（SNAP）在检测IPH（κ=0.938）和测量IPH体积方面显示出极好的一致性（ICC =0.995；95%CI：0.991 - 0.997）。MERGE与计算机断层血管造影（CTA）在检测钙化（κ=0.814）和混合钙化（κ=0.972）以及测量钙化体积方面显示出高度一致性（ICC =0.996；95%CI：0.993 - 0.997）。MERGE与数字减影血管造影（DSA）在识别溃疡方面显示出相对较强的一致性（κ=0.737）。
MERGE在识别和测量颈动脉粥样硬化斑块中的IPH和钙化方面表现出色。因此，MERGE可能是一种用于易损粥样硬化斑块的有前景的成像方法。
