3.0T MRI联合低浓度对比剂CE-MRA和灌注成像在急性缺血性脑卒中的应用价值
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摘要
目的探讨在3.0T MRI联合低浓度对比剂增强磁共振血管成像(CE-MRA)和动态磁敏感灌注成像(DSCPWI)在急性缺血性脑卒中的应用价值。方法收集南京市第一医院2017年10月～2018年3月急性脑卒中患者30例,所有患者均接受低浓度对比剂CE-MRA和DSC-PWI成像,并于24 h内接受数字减影血管造影(DSA)检查。CE-MRA和DSC-PWI均使用半剂量对比剂浓度(0.05 mmol/kg)。通过与DSA对照,评估CE-MRA对血管狭窄诊断的准确性。CE-MRA诊断血管狭窄及DSC-PWI诊断不匹配区的观察者间一致性检验使用Kappa分析。结果 CE-MRA对头颈动脉低级别(<50%)及高级别(>50%)狭窄诊断的敏感性、特异性、阳性预测值、阴性预测值分别为82.4%、100%、100%、93.8%及100%、82.4%、93.8%、100%。CE-MRA诊断动脉狭窄及DSC-PWI诊断不匹配区观察者之间一致性均好(κ=0.87、0.86)。结论 3.0T MRI联合低浓度对比剂CE-MRA和DSC-PWI是一种可行的急性缺血性脑卒中MRI扫描方案。
Objective To explore application value of low-dose contrast-enhanced MRA(CE-MRA) and dynamic susceptibility contrast perfusion imaging(DSC-PWI) at 3.0 T in patients with acute ischemic stroke. Methods Thirty patients with acute ischemic stroke in Nanjing First Hospital from October 2017 to March 2018 were enrolled. All the patients underwent low-dose CE-MRA and DSC-PWI examination, and DSA examination was performed within 24 h.Half-dose contrast agent concentration(0.05 mmol/kg) was used in both CE-MRA and DSC-PWI. The accuracy of CE-MRA in the diagnosis of arterial stenosis was evaluated by comparing with DSA. Inter-observer agreement tests for diagnosis of arterial stenosis with CE-MRA and mismatched areas with DSC-PWI were tested by Kappa analysis. Results The sensitivity, specificity, positive predictive value and negative predictive value of CE-MRA in the diaognosis of low grade(<50%) and high grade(>50%) arterial stenosis of the intracranial and cervical arteries were 82.4%,100%, 100%, 93.8%, 100% and 82.4%, 93.8%, 100%, respectively. The inter-observer agreements in the diagnosis of arterial stenosis with CE-MRA and mismatch area with DSC-PWI were both excellent(κ = 0.87, 0.86). Conclusion Low-dose CE-MRA and DSC-PWI combination at 3.0 T MRI is a feasible MRI scanning protocal for patinets with acute ischemic stroke.
Objective To explore application value of low-dose contrast-enhanced MRA(CE-MRA) and dynamic susceptibility contrast perfusion imaging(DSC-PWI) at 3.0 T in patients with acute ischemic stroke. Methods Thirty patients with acute ischemic stroke in Nanjing First Hospital from October 2017 to March 2018 were enrolled. All the patients underwent low-dose CE-MRA and DSC-PWI examination, and DSA examination was performed within 24 h.Half-dose contrast agent concentration(0.05 mmol/kg) was used in both CE-MRA and DSC-PWI. The accuracy of CE-MRA in the diagnosis of arterial stenosis was evaluated by comparing with DSA. Inter-observer agreement tests for diagnosis of arterial stenosis with CE-MRA and mismatched areas with DSC-PWI were tested by Kappa analysis. Results The sensitivity, specificity, positive predictive value and negative predictive value of CE-MRA in the diaognosis of low grade(<50%) and high grade(>50%) arterial stenosis of the intracranial and cervical arteries were 82.4%,100%, 100%, 93.8%, 100% and 82.4%, 93.8%, 100%, respectively. The inter-observer agreements in the diagnosis of arterial stenosis with CE-MRA and mismatch area with DSC-PWI were both excellent(κ = 0.87, 0.86). Conclusion Low-dose CE-MRA and DSC-PWI combination at 3.0 T MRI is a feasible MRI scanning protocal for patinets with acute ischemic stroke.
引文
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[16]苏文,陈谦,毛存南,等.3.0T MRI使用双流高压注射器进行低浓度对比剂头颈部CE-MRA成像的应用价值[J].中国医学计算机成像杂志,2018,24(2):169-172.
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[18]Tarpley J,Franc D,Tansy AP,et al.Use of Perfusion Imaging and Other Imaging Techniques to Assess Risks/Benefits of Acute Stroke Interventions[J].Curr Atheroscler Rep,2013,15(7):336.
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[20]Nael K,Mossadeghi B,Boutelier T,et al.Bayesian estimation of cerebral perfusion using reduced-contrastdose dynamic susceptibility contrast perfusion at 3T[J].Am J Neuroradiol,2015,36(4):710-718.
[2]Goyal M,Demchuk AM,Menon BK,et al.Randomized assessment of rapid endovascular treatment of ischemic stroke[J].N Engl J Med,2015,372(11):1019-1030.
[3]Campbell BCV,Mitchell PJ,Kleinig TJ,et al.Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection[J].N Engl J Med,2015,372(11):1009-1018.
[4]Tomasian A,Salamon N,Lohan DG,et al.Supraaortic arteries:contrast material dose reduction at 3.0-T high-spatial-resolution MR angiography-feasibility study[J].Radiology,2008,249(3):980-990.
[5]Ramalho M,Ramalho J,Burke LM,et al.Gadolinium Retention and Toxicity-An Update[J].Adv Chronic Kidney Dis,2017,24(3):138-146.
[6]Mcdonald RJ,Mcdonald JS,Kallmes DF,et al.Gadolinium Deposition in Human Brain Tissues after Contrast-enhanced MR Imaging in Adult Patients without Intracranial Abnormalities[J].Radiology,2017,285(2):546-554.
[7]Boujan T,Neuberger U,Pfaff J,et al.Value of ContrastEnhanced MRA versus Time-of-Flight MRA in Acute Ischemic Stroke MRI[J].AJNR Am J Neuroradiol,2018,39(9):1710-1716.
[8]Powers WJ,Rabinstein AA,Ackerson T,et al.2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2018,49(3):e46-e110.
[9]Song S.Advanced Imaging in Acute Ischemic Stroke[J].Semin Neurol,2014,33(5):436-440.
[10]Isoda H,Takehara Y,Isogai S,et al.MRA of intracranial aneurysm models:a comparison of contrast-enhanced three-dimensional MRA with time-of-flight MRA[J].JComput Assist Tomogr,2000,24(2):308-315.
[11]Lin W,Tkach JA,Haacke EM,et al.Intracranial MR angiography:application of magnetization transfer contrast and fat saturation to short gradient-echo,velocity-compensated sequences[J].Radiology,1993,186(3):753-761.
[12]Nael K,Moriarty JM,Finn JP.Low dose CE-MRA[J].Eur J Radiol,2011,80(1):2-8.
[13]de Zwart JA,Ledden PJ,van Gelderen P,et al.Signalto-noise ratio and parallel imaging performance of a 16-channel receive-only brain coil array at 3.0 Tesla[J].Magn Reson Med,2004,51(1):22-26.
[14]Rinck PA,Muller RN.Field strength and dose dependence of contrast enhancement by gadolinium-based MRcontrast agents[J].Eur Radiol,1999,9(5):998-1004.
[15]Nael K,Meshksar A,Ellingson B,et al.Combined LowDose Contrast-Enhanced MR Angiography and Perfusion for Acute Ischemic Stroke at 3T:A More Efficient Stroke Protocol[J].Am J Neuroradiol,2014,35(6):1078-1084.
[16]苏文,陈谦,毛存南,等.3.0T MRI使用双流高压注射器进行低浓度对比剂头颈部CE-MRA成像的应用价值[J].中国医学计算机成像杂志,2018,24(2):169-172.
[17]Kassner A,Merali Z.Assessment of Blood-Brain Barrier Disruption in Stroke[J].Stroke,2015,46(11):3310-3315.
[18]Tarpley J,Franc D,Tansy AP,et al.Use of Perfusion Imaging and Other Imaging Techniques to Assess Risks/Benefits of Acute Stroke Interventions[J].Curr Atheroscler Rep,2013,15(7):336.
[19]Moustafa RR,Baron JC.Clinical review:Imaging in ischaemic stroke-implications for acute management[J].Crit Care,2007,11(5):227.
[20]Nael K,Mossadeghi B,Boutelier T,et al.Bayesian estimation of cerebral perfusion using reduced-contrastdose dynamic susceptibility contrast perfusion at 3T[J].Am J Neuroradiol,2015,36(4):710-718.