Subarachnoid Hemorrhage in Patients with Good Clinical Grade: Accuracy of 3.0-T MR Angiography for Detection and Characterization.
Subarachnoid Hemorrhage in Patients with Good Clinical Grade: Accuracy of 3.0-T MR Angiography for Detection and Characterization.
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DOI：
10.1148/radiol.2017161469
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发表时间：
2017-02
期刊：
影响因子：
19.7
通讯作者：
Minghua Li;Yueqi Zhu;Hong-mei Song;Bin Gu;Haitao Lu;Yuehua Li;Hua-qiao Tan;Yingsheng Cheng
中科院分区：
文献类型：
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作者：
Minghua Li;Yueqi Zhu;Hong-mei Song;Bin Gu;Haitao Lu;Yuehua Li;Hua-qiao Tan;Yingsheng Cheng
目的评价格拉斯哥昏迷评分为15分且非造影剂材料增强计算机断层扫描（CT）结果显示急性非创伤性蛛网膜下腔出血的患者中动脉瘤检测的诊断准确性和3.0 T下三维（3D）飞行时间（TOF）磁共振（MR）血管造影的形态特征保真度。材料与方法本前瞻性研究经机构审查委员会批准，患者提供知情同意书。共纳入277例患者，这些患者没有经历过创伤，但非增强CT显示蛛网膜下腔出血，格拉斯哥昏迷评分为15，并接受了3D TOF MR血管造影和数字减影血管造影（DSA）（参考标准）。三名对临床和DSA结果不知情的观察者独立分析了所有3D TOF MR血管造影数据集。应用受试者工作特征曲线分析3D TOF MR血管造影对动脉瘤的检测，采用基于患者和动脉瘤的评价。进行多变量逻辑回归分析，以确定动脉瘤特异性变量，包括大小、形状（子囊/分叶/边缘）、颈宽（宽，如果> 4 mm或如果基底-颈比< 2），以及与邻近动脉的关系，这些变量显著影响3D TOF MR血管造影的形态评估。结果225例患者DSA显示动脉瘤。在基于患者和血管动力学的评估中，3D TOF MR血管造影的准确性分别为96.8%（268/277）和96.6%（309/320），灵敏度为98.2%（219/223）和98.1%（260/265），特异性91%（49/54）和89%阳性预测值分别为97.8%（219/224）和97.7%（260/266），阴性预测值分别为92%（49/53）和91%（49/54）。形态学特征显示的准确性为92.5%（236/255）的大小，86.3%（220/255）的颈部宽度，94.5%（241/255）的形状和96.9%（247/255）与相邻血管的关系。动脉瘤颈宽度是唯一显著影响3D TOF MR血管造影形态评估的变量（比值比，0.378; 95%置信区间：0.337，8.347; P = .004）。结论对于格拉斯哥昏迷评分为15分的稳定期蛛网膜下腔出血患者，三维TOF MR血管成像能准确显示脑动脉瘤及其形态学特征。© RSNA，2017.
Purpose To evaluate the diagnostic accuracy of aneurysm detection and the fidelity of morphologic characterization of three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography at 3.0 T in patients with a Glasgow coma score of 15 and noncontrast material-enhanced computed tomography (CT) findings that showed acute nontraumatic subarachnoid hemorrhage. Materials and Methods The institutional review board approved this prospective study, and patients provided informed consent. A total of 277 patients who had not experienced trauma but in whom nonenhanced CT showed subarachnoid hemorrhage, who had a Glasgow coma score of 15, and who underwent both 3D TOF MR angiography and digital subtraction angiography (DSA) (the reference standard) were included. Three observers who were blinded to clinical and DSA results independently analyzed all 3D TOF MR angiographic data sets. The receiver operating characteristic curve was applied to analysis of the detection of aneurysms with 3D TOF MR angiography by using patient- and aneurysm-based evaluations. Multivariate logistic regression analysis was performed to identify aneurysm-specific variables, including size, shape (daughter sac/lobulation/margin), neck width (wide if > 4 mm or if fundus-to-neck ratio was < 2), and relation to adjacent artery, that significantly affected morphologic assessment with 3D TOF MR angiography. Results Aneurysms were depicted with DSA in 225 patients. In patient- and aneurysm-based evaluations, respectively, 3D TOF MR angiography yielded accuracies of 96.8% (268 of 277) and 96.6% (309 of 320), sensitivities of 98.2% (219 of 223) and 98.1% (260 of 265), specificities of 91% (49 of 54) and 89% (49 of 55), positive predictive values of 97.8% (219 of 224) and 97.7% (260 of 266), and negative predictive values of 92% (49 of 53) and 91% (49 of 54). Accuracy of display of morphologic features was 92.5% (236 of 255) for size, 86.3% (220 of 255) for neck width, 94.5% for shape (241 of 255), and 96.9% (247 of 255) for relationship to adjacent vessel. Width of aneurysm neck was the only variable that significantly affected the morphologic assessment of 3D TOF MR angiography (odds ratio, 0.378; 95% confidence interval: 0.337, 8.347; P = .004). Conclusion Three-dimensional TOF MR angiography can accurately depict cerebral aneurysms and accurately display their morphologic features in stable patients with subarachnoid hemorrhage and a Glasgow coma score of 15. © RSNA, 2017.