定量磁共振血管造影在蛛网膜下腔出血后脑血管痉挛评估中的替代成像技术。
Quantitative magnetic resonance angiography as an alternative imaging technique in the assessment of cerebral vasospasm after subarachnoid hemorrhage.
机构信息
Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
出版信息
Interv Neuroradiol. 2024 Apr;30(2):271-279. doi: 10.1177/15910199221138167. Epub 2022 Nov 10.
INTRODUCTION
The major mechanism of morbidity of delayed cerebral ischemia after subarachnoid hemorrhage (SAH) is considered to be severe vasospasm. Quantitative MRA (QMRA) provides direct measurements of vessel-specific volumetric blood flow and may permit a clinically relevant assessment of the risk of ischemia secondary to cerebral vasospasm.
PURPOSE
To evaluate the utility of QMRA as an alternative imaging technique for the assessment of cerebral vasospasm after SAH.
METHODS
QMRA volumetric flow rates of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were compared with vessel diameters on catheter-based angiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of QMRA for detecting cerebral vasospasm was determined by receiver-operating characteristic curves. Spearman correlation coefficients were calculated for QMRA flow versus angiographic vessel diameter.
RESULTS
Sixty-six vessels (10 patients) were evaluated with QMRA and catheter-based angiography. The median percent QMRA flow of all vessels with angiographic vasospasm (55.0%, IQR 34.3-71.6%) was significantly lower than the median percent QMRA flow of vessels without vasospasm (91.4%, IQR 81.4-100.4%) (p < 0.001). Angiographic vasospasm reduced QMRA-assessed flow by 23 ± 5 (p = 0.018), 95 ± 12 (p = 0.042), and 16 ± 4 mL/min (p = 0.153) in the ACA, MCA, and PCA, respectively, compared to vessels without angiographic vasospasm. The sensitivity, specificity, PPV, and NPV of QMRA for the discrimination of cerebral vasospasm was 84%, 72%, 84%, and 72%, respectively, for angiographic vasospasm >25% and 91%, 60%, 87%, and 69%, respectively, for angiographic vasospasm >50%. The Spearman correlation indicated a significant association between QMRA flows and vessel diameters ( = 0.71, p < 0.001).
CONCLUSION
Reduction in QMRA flow correlates with angiographic vessel narrowing and may be useful as a non-invasive imaging modality for the detection of cerebral vasospasm after SAH.
简介
蛛网膜下腔出血（SAH）后迟发性脑缺血的主要发病机制被认为是严重的血管痉挛。定量磁共振血管造影（QMRA）可直接测量血管特定的容积血流，可能允许对继发于脑血管痉挛的缺血风险进行临床相关评估。
目的
评估 QMRA 作为评估蛛网膜下腔出血后脑血管痉挛的替代成像技术的效用。
方法
比较了前脑动脉（ACA）、大脑中动脉（MCA）和脑后动脉（PCA）的 QMRA 容积流量与基于导管的血管造影的血管直径。通过受试者工作特征曲线确定 QMRA 检测脑血管痉挛的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）。计算了 QMRA 流量与血管造影血管直径之间的斯皮尔曼相关系数。
结果
用 QMRA 和基于导管的血管造影评估了 66 个血管（10 个患者）。血管痉挛的所有血管的 QMRA 流量中位数（55.0%，IQR 34.3-71.6%）明显低于无血管痉挛的血管的 QMRA 流量中位数（91.4%，IQR 81.4-100.4%）（p<0.001）。血管造影显示血管痉挛使 QMRA 评估的流量分别减少了 23±5（p=0.018）、95±12（p=0.042）和 16±4mL/min（p=0.153），与无血管造影血管痉挛的血管相比。对于血管造影>25%的血管痉挛，QMRA 的灵敏度、特异性、PPV 和 NPV 分别为 84%、72%、84%和 72%，对于血管造影>50%的血管痉挛，QMRA 的灵敏度、特异性、PPV 和 NPV 分别为 91%、60%、87%和 69%。斯皮尔曼相关表明 QMRA 流量与血管直径之间存在显著相关性（r=0.71，p<0.001）。
结论
QMRA 流量的降低与血管造影狭窄相关，可能作为一种非侵入性成像方式，用于检测蛛网膜下腔出血后的脑血管痉挛。
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