Circumferential Thick Enhancement at Vessel Wall MRI Has High Specificity for Intracranial Aneurysm Instability
Circumferential Thick Enhancement at Vessel Wall MRI Has High Specificity for Intracranial Aneurysm Instability
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DOI：
10.1148/radiol.2018172879
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发表时间：
2018-10-01
期刊：
影响因子：
19.7
通讯作者：
Naggara, Olivier
中科院分区：
文献类型：
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作者：
Edjlali, Myriam;Guedon, Alexis;Naggara, Olivier
目的：探讨MRI血管壁强化对稳定性和不稳定性未破裂颅内动脉瘤(UIA)的鉴别诊断价值。材料和方法：选择2012年11月至2016年1月收治的UIA患者。对稳定(6个月以上偶发且无变化)或不稳定(症状或变化6个月以上)的UIA患者，在3T时采集血管壁MR图像。采用4级强化分级对每个动脉瘤进行评估：0，无强化；1，局灶性强化；2，周边薄；3，周边厚(>；1 mm)。使用kappa统计和95%可信区间(CI)评估读者之间和读者内部对增强的存在和分级的一致性。比较不同增强级别对区分稳定和不稳定动脉瘤的敏感性、特异性以及阴性和阳性预测值。结果：研究纳入263例患者333个动脉瘤。在存在强化(Kappa值，0.82[95%CI：0.67，0.99]和0.87[95%CI：0.7，1.0])和增强级别(Kappa=0.92[95%CI：0.87，0.95])方面，读者间和读者内的一致性都很好。在未破裂动脉瘤(n=307)中，3级强化对区分稳定和不稳定病变的特异性最高(84.4%；276例，233例；95%CI：80.1%，88.7%；P=0.02)，阴性预测值(94.3%，233例)。3级强化与动脉瘤不稳定性(P_1 Mm)有显着相关性，壁强化的周围型对区分稳定性和不稳定性的特异性最高。(C)RSNA，2018年
Purpose: To identify wall enhancement patterns on vessel wall MRI that discriminate between stable and unstable unruptured intracranial aneurysm (UIA).Materials and Methods: Patients were included from November 2012 through January 2016. Vessel wall MR images were acquired at 3 T in patients with stable (incidental and nonchanging over 6 months) or unstable (symptomatic or changing over 6 months) UIA. Each aneurysm was evaluated by using a four-grade classification of enhancement: 0, none; 1, focal; 2, thin circumferential; and 3, thick (>1 mm) circumferential. Inter-and intrareader agreement for the presence and the grade of enhancement were assessed by using kappa statistics and 95% confidence interval (CI). The sensitivity, specificity, and negative and positive predictive values of each enhancement grade for differentiating stable from unstable aneurysms was compared.Results: The study included 263 patients with 333 aneurysms. Inter-and intrareader agreement was excellent for both the presence of enhancement (kappa values, 0.82 [95% CI: 0.67, 0.99] and 0.87 [95% CI: 0.7, 1.0], respectively) and enhancement grade (kappa = 0.92 [95% CI: 0.87, 0.95]). In unruptured aneurysms (n = 307), grade 3 enhancement exhibited the highest specificity (84.4%; 233 of 276; 95% CI: 80.1%, 88.7%; P=.02) and negative predictive value (94.3%; 233 of 247) for differentiating between stable and unstable lesions. There was a significant association between grade 3 enhancement and aneurysm instability (P1 mm) circumferential pattern of wall enhancement demonstrated the highest specificity for differentiating between stable and unstable aneurysms. (c) RSNA, 2018