单纯磁共振血管造影在儿童烟雾病诊断和手术规划中是不够的。
Magnetic Resonance Angiography Alone Is Insufficient for Diagnosis and Surgical Planning in Children With Moyamoya.
机构信息
Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
出版信息
Pediatr Neurol. 2024 Oct;159:1-3. doi: 10.1016/j.pediatrneurol.2024.06.008. Epub 2024 Jun 25.
BACKGROUND
The gold standard for evaluation of the severity of moyamoya vasculopathy is the Suzuki grade determined with cerebral catheter angiography (CA). With greater use of magnetic resonance angiography (MRA) it is important to understand if MRA is truly comparable to CA.
METHODS
Children with moyamoya were evaluated using the Suzuki score for CA and the modified MRA six-stage Suzuki score to describe the angiographic findings in moyamoya from initial narrowing of the distal internal carotid artery to the "puff of smoke" appearance of the lenticulostriate collaterals and finally to the disappearance of this network of collaterals. Using Cohen kappa we compared Suzuki grade based on CA with MRA in the same patients.
RESULTS
A total of 27 children with moyamoya were reviewed. We calculated a weighted Cohen kappa of 0.49 (P < 0.0001), which is a moderate correlation.
CONCLUSIONS
We suggest caution in the reliance on MRA for the diagnosis and evaluation of severity of moyamoya in children.
背景
评估烟雾病严重程度的金标准是通过脑血管造影（CA）确定的 Suzuki 分级。随着磁共振血管造影（MRA）的广泛应用，了解 MRA 是否与 CA 真正可比非常重要。
方法
对患有烟雾病的儿童进行 Suzuki 分级评估，采用改良的 MRA 六阶段 Suzuki 分级来描述烟雾病的血管造影表现，从远端颈内动脉初始狭窄到纹状体侧支的“烟雾状”外观，最后到侧支网络的消失。我们使用 Cohen kappa 在同一患者中比较了基于 CA 的 Suzuki 分级和 MRA。
结果
共回顾了 27 例烟雾病患儿。我们计算出加权 Cohen kappa 值为 0.49（P<0.0001），表明存在中度相关性。
结论
我们建议在依赖 MRA 诊断和评估儿童烟雾病的严重程度时要谨慎。
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