Ryu Jiwook, Lee Kyung Mi, Kim Hyug-Gi, Choi Seok Keun, Kim Eui Jong
Department of Neurosurgery, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea.
Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea.
Diagnostics (Basel). 2022 Feb 8;12(2):432. doi: 10.3390/diagnostics12020432.
Intracranial vertebral artery dissection (VAD) is being increasingly recognized as a leading cause of Wallenberg syndrome and subarachnoid hemorrhage. Conventional angiography is considered the standard diagnostic modality, but the diagnosis of VAD remains challenging. This study aimed to compare the diagnostic performance of high-resolution vessel wall imaging (HR-VWI) with digital subtraction angiography (DSA) for intracranial VAD.
Twenty-four patients with 27 VADs, who underwent both HR-VWI and DSA within 2 weeks, were consecutively enrolled in the study from March 2016 to September 2020. HR-VWI and DSA were performed to diagnose VAD and to categorize its angiographic features as either definite dissection or suspicious dissection. Features of HR-VWI were used to evaluate direct arterial wall imaging. The reference standard was set from the clinicoradiologic diagnosis. Two independent raters evaluated the angiographic features, dissection signs, and interrater agreement. Each subject was also dichotomized into two groups (suspicious or definite VAD) in each modality, and diagnosis from HR-VWI and DSA was compared with the final diagnosis by consensus.
HR-VWI had higher agreement (90.6% vs. 53.1%) with the final diagnosis and better interrater reliability (kappa value (κ) = 0.91; 95% confidence interval (CI) = 0.64-1.00) compared with DSA (κ = 0.58; 95% CI = 0.35-1.00). HR-VWI provided a more detailed identification of dissection signs (77.7% vs. 22.2%) and better reliability (κ = 0.88; 95% CI = 0.58-1.00 vs. κ = 0.75; 95% CI = 0.36-1.00), compared to DSA. HR-VWI was comparable to DSA for the depiction of angiographic features for VAD.
HR-VWI may be useful to evaluate VAD, with better diagnostic confidence compared to DSA.
颅内椎动脉夹层（VAD）日益被认为是延髓背外侧综合征和蛛网膜下腔出血的主要原因。传统血管造影被视为标准诊断方式，但VAD的诊断仍具有挑战性。本研究旨在比较高分辨率血管壁成像（HR-VWI）与数字减影血管造影（DSA）对颅内VAD的诊断性能。
2016年3月至2020年9月，连续纳入24例患有27处VAD且在2周内同时接受HR-VWI和DSA检查的患者。进行HR-VWI和DSA以诊断VAD并将其血管造影特征分类为明确夹层或可疑夹层。HR-VWI的特征用于评估动脉壁直接成像。参考标准根据临床放射学诊断确定。两名独立评估者评估血管造影特征、夹层征象及评估者间的一致性。每种检查方式下，每个受试者还被分为两组（可疑或明确VAD），并将HR-VWI和DSA的诊断与最终达成共识的诊断进行比较。
与DSA相比，HR-VWI与最终诊断的一致性更高（90.6%对53.1%），评估者间可靠性更好（kappa值（κ）=0.91；95%置信区间（CI）=0.64 - 1.00），而DSA的κ = 分别为0.58；95%CI = 0.35 - 1.00）。与DSA相比，HR-VWI能更详细地识别夹层征象（77.7%对22.2%），可靠性也更好（κ = 0.88；95%CI = 0.58 - 1.00对κ = 0.75；95%CI = 0.36 - 1.00）。在描绘VAD的血管造影特征方面，HR-VWI与DSA相当。
HR-VWI可能有助于评估VAD，与DSA相比具有更高的诊断可信度。
