Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Korean J Radiol. 2024 Jun;25(6):575-588. doi: 10.3348/kjr.2023.1241.
Differentiating intracranial aneurysms from normal variants using CT angiography (CTA) or MR angiography (MRA) poses significant challenges. This study aimed to evaluate the efficacy of proton-density MRA (PD-MRA) compared to high-resolution time-of-flight MRA (HR-MRA) in diagnosing aneurysms among patients with indeterminate findings on conventional CTA or MRA.
In this retrospective analysis, we included patients who underwent both PD-MRA and HR-MRA from August 2020 to July 2022 to assess lesions deemed indeterminate on prior conventional CTA or MRA examinations. Three experienced neuroradiologists independently reviewed the lesions using HR-MRA and PD-MRA with reconstructed voxel sizes of 0.25 mm or 0.2 mm, respectively. A neurointerventionist established the gold standard with digital subtraction angiography. We compared the performance of HR-MRA, PD-MRA (0.25-mm voxel), and PD-MRA (0.2-mm voxel) in diagnosing aneurysms, both per lesion and per patient. The Fleiss kappa statistic was used to calculate inter-reader agreement.
The study involved 109 patients (average age 57.4 ± 11.0 years; male:female ratio, 11:98) with 141 indeterminate lesions. Of these, 78 lesions (55.3%) in 69 patients were confirmed as aneurysms by the reference standard. PD-MRA (0.25-mm voxel) exhibited significantly higher per-lesion diagnostic performance compared to HR-MRA across all three readers: sensitivity ranged from 87.2%-91.0% versus 66.7%-70.5%; specificity from 93.7%-96.8% versus 58.7%-68.3%; and accuracy from 90.8%-92.9% versus 63.8%-69.5% ( ≤ 0.003). Furthermore, PD-MRA (0.25-mm voxel) demonstrated significantly superior per-patient specificity and accuracy compared to HR-MRA across all evaluators ( ≤ 0.013). The diagnostic accuracy of PD-MRA (0.2-mm voxel) surpassed that of HR-MRA and was comparable to PD-MRA (0.25-mm voxel). The kappa values for inter-reader agreements were significantly higher in PD-MRA (0.820-0.938) than in HR-MRA (0.447-0.510).
PD-MRA outperformed HR-MRA in diagnostic accuracy and demonstrated almost perfect inter-reader consistency in identifying intracranial aneurysms among patients with lesions initially indeterminate on CTA or MRA.
使用 CT 血管造影（CTA）或磁共振血管造影（MRA）区分颅内动脉瘤与正常变异存在显著挑战。本研究旨在评估质子密度 MRA（PD-MRA）在诊断 CTA 或 MRA 初步检查结果不确定的患者的动脉瘤方面与高分辨率时间飞跃 MRA（HR-MRA）的效果。
在这项回顾性分析中，我们纳入了 2020 年 8 月至 2022 年 7 月期间同时接受 PD-MRA 和 HR-MRA 检查的患者，以评估先前 CTA 或 MRA 检查结果不确定的病变。三位有经验的神经放射学家分别使用 HR-MRA 和 PD-MRA（体素分辨率分别为 0.25mm 或 0.2mm）对病变进行独立评估。神经介入医生以数字减影血管造影为金标准。我们比较了 HR-MRA、PD-MRA（0.25mm 体素）和 PD-MRA（0.2mm 体素）在诊断患者的病变和个体动脉瘤方面的性能。使用 Fleiss Kappa 统计量计算读者间的一致性。
该研究纳入了 109 名患者（平均年龄 57.4±11.0 岁；男女比例 11：98），共 141 个不确定病变。其中，69 名患者的 78 个病变（55.3%）经参考标准证实为动脉瘤。PD-MRA（0.25mm 体素）在三位读者中均表现出比 HR-MRA 更高的病变诊断性能：敏感性范围为 87.2%-91.0%与 66.7%-70.5%；特异性范围为 93.7%-96.8%与 58.7%-68.3%；准确性范围为 90.8%-92.9%与 63.8%-69.5%（≤0.003）。此外，PD-MRA（0.25mm 体素）在所有评估者中均表现出比 HR-MRA 更高的患者特异性和准确性（≤0.013）。PD-MRA（0.2mm 体素）的诊断准确性优于 HR-MRA，与 PD-MRA（0.25mm 体素）相当。读者间一致性的 Kappa 值在 PD-MRA（0.820-0.938）中明显高于 HR-MRA（0.447-0.510）。
PD-MRA 在诊断准确性方面优于 HR-MRA，在识别 CTA 或 MRA 初步检查结果不确定的患者的颅内动脉瘤方面具有近乎完美的读者间一致性。
