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目的分析自发性头颈动脉夹层(SCAD)在三维容积各向同性快速自旋回波(3D-VISTA)高分辨率磁共振成像(HRMRI)中的影像学特征,并探讨3D-VISTA HRMRI在SCAD的应用价值。方法搜集头颈部血管同时行DSA及3D-VISTA扫描的51例患者(65支血管),以DSA为诊断金标准,计算3D-VISTA诊断SCAD的敏感性、特异性等指标。结果 DSA及3D-VISTA分别诊断夹层17例(19支血管)和19例(24支)。3D-VISTA诊断夹层敏感性为84.2%,特异性为82.6%,阳性预测值为66.7%,阴性预测值为92.7%。壁间血肿(14支)、内膜片(13支)、双腔征(8支)、动脉瘤样扩张(6支)、壁间血肿或假腔沿真腔呈螺旋状走行(9支)为SCAD在3D-VISTA中的特征性影像征象。结论 3D-VISTA能同时显示管腔及管壁信息,对壁间血肿敏感性高,对于其他影像学检查无法确诊的夹层病例,可行病变段血管3D-VISTA扫描,提高诊断正确率。
Objective To analyze the imaging features of spontaneous carotid artery dissection (SCAD) in 3D-VIS high resolution magnetic resonance imaging (HRMRI) and to explore the application of 3D-VISTA HRMRI in SCAD value. Methods Totally 51 patients (65 vessels) who underwent both DSA and 3D-VISTA scans of head and neck vessels were collected. The sensitivity, specificity and specificity of 3D-VISTA in diagnosing SCAD were calculated using DSA as the gold standard. Results DSA and 3D-VISTA diagnosed 17 cases (19 vessels) and 19 cases (24 vessels) respectively. 3D-VISTA diagnosis of mesenchyme sensitivity was 84.2%, specificity was 82.6%, positive predictive value was 66.7%, negative predictive value was 92.7%. Interhemispheric hematomas (14), intima (13), double lumen syndrome (8), aneurysmal dilatation (6), interhemiscal hematoma or false lumen along the true lumen (9) SCAD in 3D-VISTA in the characteristic image signs. Conclusion 3D-VISTA can display both lumen and wall information and high sensitivity to intramural hematoma. For other dissection cases with unidentifiable imaging findings, 3D-VISTA can be used to improve the diagnostic accuracy.