Accelerated Two-Point Dixon MR Angiography Improves Diagnostic Performance for Cervical Artery Diseases.
Accelerated Two-Point Dixon MR Angiography Improves Diagnostic Performance for Cervical Artery Diseases.
复制标题
加速两点 Dixon MR 血管造影可提高颈动脉疾病的诊断性能。
DOI：
10.1002/jmri.28122
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发表时间：
2022
影响因子：
4.4
通讯作者：
Abe O.
中科院分区：
文献类型：
--
作者：
Amemiya S;Takei N;Ueyama T;Fujii K;Takao H;Yasaka K;Watanabe Y;Kamiya K;Abe O.
研究背景非增强磁共振血管造影（MRA）常用于治疗急性和慢性颈大动脉疾病，但较长的扫描时间限制了其临床应用。目的开发一种快速颈部MRA并测试其诊断性能。研究类型前瞻性。人群颈动脉疾病患者（n= 32，男17例），场强/序列3.0T;加速两点狄克逊三维笛卡尔扰相梯度回波（FLEXA）和常规飞行时间MRA（cMRA）所有患者均行FLEXA（1′28″）和cMRA（6′47″）扫描。定量评价（动脉与背景信号比和模糊度量）和定性评价，使用由三位委员会认证的放射科医生的灵敏度、特异性和阳性/阴性预测值（PPV/NPV）以及血管和斑块可视化评分测量的诊断性能进行定性评价。（具有10年、11年和12年的经验）使用最大强度投影（MIP）进行管腔疾病的独立读数和斑块的轴向图像。参考标准分别为对比增强血管造影和脂肪饱和T1加权图像。统计学检验使用配对检验、Wilcoxon符号秩检验、McNemar检验或卡方检验（如适用）比较FLEXA和cMRA之间的所有测量值。使用Cohen κ评估阅片员间一致性。P< 0.05被认为具有统计学显著性。（FLEXA：7.20 ± 1.63 [脂肪]; 4.26 ± 0.52 [肌肉]; cMRA：2.57 ± 0.49 [脂肪]），而图像模糊明显较少（FLEXA：0.24 ± 0.016; cMRA：0.30 ± 0.029）。在管腔疾病检测中，灵敏度（FLEXA：0.97/0.91/0.91; cMRA：0.71/0.69/0.63），特异性（FLEXA：0.98/0.93/0.98; cMRA：0.93/0.85/0.92），PPV（FLEXA：0.92/0.86/0.86; cMRA：0.64/0.5/0.58）和NPV（FLEXA：0.99/0.98/0.98; cMRA：0.92/0.91/0.9）对于FLEXA显著较高。FLEXA的阅片员间一致性为实质性至几乎完美（κ= 0.82/0.86/0.78），cMRA的阅片员间一致性为中度至实质性（κ= 0.67/0.56/0.57）。FLEXA的MIP可视化评分显著更高，阅片者间一致性基本上接近完美（FLEXA：κ= 0.83/0.86/0.82; cMRA：κ= 0.89/0.79/0.79）。在斑块检测中，2/3名阅片者的灵敏度（FLEXA：0.9/0.9/0.7; cMRA：0.3/0.6/0.2）和特异性（FLEXA：1/0.87/1; cMRA：0.93/0.63/0.97）显著高于FLEXA。阅片员间斑块检测一致性为一般至实质性（FLEXA：κ= 0.63/0.69/0.48; cMRA：κ= 0.21/0.45/0.20）。在所有阅片者中，并排斑块和血管壁可视化上级FLEXA，阅片者间一致性为中度至显著（斑块：κ= 0.73/0.73/0.77;血管壁：κ= 0.57/0.40/0.39）.Data ConclusionFLEXA增强了颈部动脉系统的可视化，提高了颈部动脉疾病患者管腔异常和斑块的诊断性能。证据等级1技术疗效阶段2
BackgroundNonenhanced MR angiography (MRA) studies are often used to manage acute and chronic large cervical artery disease, but lengthy scan times limit their clinical usefulness.PurposeTo develop an accelerated cervical MRA and test its diagnostic performance.Study TypeProspective.PopulationPatients with cervical artery disease (n= 32, 17 males).Field Strength/Sequence3.0 T; accelerated two‐point Dixon three‐dimensional Cartesian spoiled gradient‐echo (FLEXA) and conventional time‐of‐flight MRA (cMRA) sequences.AssessmentAll patients underwent FLEXA (1′28″) and cMRA (6′47″) acquisitions. Quantitative evaluation (artery‐to‐background signal ratio and a blur metric) and qualitative evaluation using diagnostic performance measured by the sensitivity, specificity, and positive/negative predictive values (PPV/NPV), and vessel and plaque visualization scores from three board‐certified radiologists' (with 10, 11, and 12 years of experience) independent readings using maximum intensity projection (MIP) for luminal diseases and axial images for plaque. The reference standards were contrast‐enhanced angiography and fat‐saturated T1‐weighted images, respectively.Statistical TestsAll measures were compared between FLEXA and cMRA using the pairedt, Wilcoxon signed‐rank, McNemar's, or chi‐squared test, as appropriate. Interreader agreement was assessed using Cohen'sκ.P< 0.05 was considered statistically significant.ResultsThe artery‐to‐background signal ratio was significantly higher for FLEXA (FLEXA: 7.20 ± 1.63 [fat]; 4.26 ± 0.52 [muscle]; cMRA: 2.57 ± 0.49 [fat]), while image blurring was significantly less (FLEXA: 0.24 ± 0.016; cMRA: 0.30 ± 0.029). In luminal disease detection, sensitivity (FLEXA: 0.97/0.91/0.91; cMRA:0.71/0.69/0.63), specificity (FLEXA: 0.98/0.93/0.98; cMRA:0.93/0.85/0.92), PPV (FLEXA: 0.92/0.86/0.86; cMRA: 0.64/0.5/0.58), and NPV (FLEXA: 0.99/0.98/0.98; cMRA: 0.92/0.91/0.9) were significantly higher for FLEXA. interreader agreement was substantial to almost perfect for FLEXA (κ= 0.82/0.86/0.78) and moderate to substantial for cMRA (κ= 0.67/0.56/0.57). MIP visualization scores were significantly higher for FLEXA, with substantial to almost perfect interreader agreement (FLEXA:κ= 0.83/0.86/0.82; cMRA:κ= 0.89/0.79/0.79). In plaque detection, sensitivity (FLEXA: 0.9/0.9/0.7; cMRA: 0.3/0.6/0.2) and specificity (FLEXA: 1/0.87/1; cMRA: 0.93/0.63/0.97) were significantly higher for FLEXA in two of three readers. The interreader plaque detection agreement was fair to substantial (FLEXA:κ= 0.63/0.69/0.48; cMRA:κ= 0.21/0.45/0.20). Side‐by‐side plaque and vessel wall visualization was superior for FLEXA in all readers, with moderate to substantial interreader agreement (plaque:κ= 0.73/0.73/0.77; vessel wall:κ= 0.57/0.40/0.39).Data ConclusionFLEXA enhanced visualization of the cervical arterial system and improved diagnostic performance for luminal abnormalities and plaques in patients with cervical artery diseases.Level of Evidence1Technical Efficacy Stage2