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目的探讨一种新型的磁共振血管成像技术——椎-基底动脉平行解剖磁共振成像(basi-parallel anatomic scanning,BPAS)联合磁共振血管成像(magnetic resonance angiography,MRA)对椎-基底动脉颅内段夹层鉴别诊断的作用。方法参照文献BPAS的扫描条件,由西安交通大学第二附属医院影像科医师及技师探寻适合3.0-MR的扫描及图像处理参数,回顾性分析神经内科部分住院及门诊MRA显示为椎-基底动脉颅内段纤细或不显影、同期进行了BPAS检查的142例患者,其中临床疑诊为动脉夹层者20例,动脉硬化者60例,先天发育不良者62例,由两位未知患者临床资料的影像医师分别对所有患者的MRA及BPAS影像进行阅片,对20例临床疑诊夹层的病例MRA及MRA+BPAS影像诊断结果进行ROC曲线分析,并对两位影像医师的诊断结果进行一致性评估。结果两位影像医师对20例夹层患者MRA+BPAS及MRA阅片诊断结果的ROC曲线下面积分别为0.93vs 0.70和0.96 vs 0.75(P<0.01),提示MRA联合BPAS比单纯MRA的ROC曲线下面积明显增加;MRA联合BPAS诊断椎-基底动脉颅内段夹层的灵敏度比单纯MRA高(100%vs 55%,100%vs 60%,P<0.01);而两种诊断方法的特异度无显著差异(86.89%vs 85.25%,P=0.85;92.62%vs 90.16%,P=0.65);两位影像医师对椎-基底动脉颅内段夹层的诊断结果具有高度的一致性(Kappa=0.85)。结论 BPAS检查可通过显示血管外径与MRA联合精确评估椎-基底动脉颅内段血管状况,区分该部位血管病变为夹层、动脉硬化或先天性发育不良,为该部位血管病变临床治疗方案提供依据。
Objective To investigate the effect of vertebrobasilar artery biopsy (BPA) combined with magnetic resonance angiography (MRA) on intracranial of vertebrobasilar artery Section sandwich differential diagnosis. Methods According to the scanning conditions of the literature BPAS, scan and image processing parameters suitable for 3.0-MR were explored by imaging physicians and technicians of the Second Affiliated Hospital of Xi’an Jiaotong University. The retrospective analysis of neurological department inpatient and outpatient MRA showed vertebrobasilar artery 142 cases of BPAS examination in the same period, including clinical suspected arterial dissection in 20 cases, 60 cases of atherosclerosis, congenital dysplasia in 62 cases, from two unknown patients with clinical data images The physicians read the MRA and BPAS images of all the patients respectively. ROC curve analysis was performed on the MRA and MRA + BPAS images of 20 suspected cases of suspected dissection, and the diagnostic results of the two imaging doctors were evaluated. Results The area under the ROC curve of MRA + BPAS and MRA in 20 patients with dissection was 0.93 vs 0.70 and 0.96 vs 0.75, respectively (P <0.01), suggesting that under the ROC curve of MRA combined with BPAS (P <0.01). MRA combined with BPAS in the diagnosis of vertebrobasilar intracranial intracranial dissection was more sensitive than MRA alone (100% vs 55%, 100% vs 60%, P <0.01). However, the specificity of MRA combined with BPAS was not significant (86.89% vs 85.25%, P = 0.85; 92.62% vs 90.16%, P = 0.65). There was a high degree of agreement between the two physicians in diagnosing intracranial segments of the vertebrobasilar artery (Kappa = 0.85). Conclusions BPAS can accurately assess the intracranial vascular status of vertebrobasilar artery by combining the vascular diameter with MRA, and distinguish the vascular lesion as dissection, atherosclerosis or congenital dysplasia, and provide a basis for clinical treatment of vascular lesions in this area .