中国脑血管病杂志2017，Vol.14Issue(7)：345-350,355,7.DOI:10.3969/j.issn.1672-5921.2017.07.003
磁共振血管成像在支架辅助弹簧圈栓塞颅内动脉瘤术后患者随访中的应用
Application of magnetic resonance angiography in the follow-up of patients after embolization of intracranial aneurysms with stent-assisted coils
摘要
Abstract
Objective To evaluate the application of 3.0 T magnetic resonance angiography (MRA) in follow-up after embolization of intracranial aneurysms with stent-assisted coils.Methods From June 2013 to June 2015,32 consecutive patients with subarachnoid hemorrhage due to ruptured intracranial aneurysms underwent stent-assisted coil embolization at the Department of Neurosurgery,the Sixth People′s Hospital of Shenzhen were enrolled retrospectively,including 12 males and 20 female,their mean age was 56±10 years.All patients were confirmed to be solitary intracranial aneurysms by digital subtraction angiography (DSA) before embolization.They were followed up with 3.0 T time of flight MRA (TOF-MRA) and contrast enhanced MRA (CE-MRA) at 1 to 2 years after embolization.DSA findings were served as the "golden standard".The effect of aneurysm embolization (stabilization,further embolization,recanalization/recurrence) and patency of the parent arteries (without stenosis/mild stenosis,moderate to severe stenosis and occlusion) were compared.Results (1) The comparisons of evaluating the aneurysmal effects and consistencies of DSA among TOF-MRA,CE-MRA and TOF-MRA+source images after stent-assisted coil embolization were poor (Kappa=0.039,P=0.002),medium (Kappa=0.582,P<0.01),and higher (Kappa=0.615,P<0.01),respectively.(2) The comparison of the consistencies in the patency of the parent artery after stent-assisted coil embolization between TOF-MRA,CE-MRA and DSA were poor (Kappa=0.171,P=0.211;Kappa=0.376,P=0.010).(3) With the DSA findings as reference,the accuracy rates of TOF-MRA,TOF-MRA+source images and CE-MRA for interpretation of aneurysm embolization were 37.5% (12/32),75.0% (24/32),and 71.9% (23/32),respectively.TOF-MRA compared with TOF-MRA+source images and CE-MRA respectively,there were significant differences in the accuracy rates (χ2=9.04,P=0.003;χ2=7.63,P=0.006);there were no significant differences in the accuracy rates between TOF-MRA+source images and CE-MRA (χ2=0.08,P=0.777).(4) With the DSA findings as reference,the accuracy rates of TOF-MRA and CE-MRA for interpretation of the patency of the parent artery were 37.5% (12/32) and 62.5% (20/32) respectively.There was no significant difference in the accuracy rate (χ2=4.67,P=0.097).Conclusions The accuracy rate of 3.0 T CE-MRA for evaluating the embolization effect of intracranial aneurysms after stent-assisted coil embolization was superior to that of TOF-MRA.It can be used as a preferred non-invasive examination during the follow-up.TOF-MRA+source images are equivalent to CE-MRA,however,TOF-MRA and CE-MRA for the evaluation of the accuracy of patency of the parent arteries are low.For positive or indeterminate results of MRA examinations,the individualized analysis should be performed,if necessary,perform DSA examination.关键词
颅内动脉瘤/磁共振血管造影术/数字减影术,血管造影/血管内栓塞/随访研究Key words
Intracranial aneurysm/Magnetic resonance angiography/Angiography/digital subtraction/Endovascular embolization/Follow-up study引用本文复制引用
宋伟健,李宝民,胡深,刘欣民,魏强国..磁共振血管成像在支架辅助弹簧圈栓塞颅内动脉瘤术后患者随访中的应用[J].中国脑血管病杂志,2017,14(7):345-350,355,7.基金项目
深圳市科技创新委员会项目(JCYJ 20140411092959835) （JCYJ 20140411092959835）
