Analysis on evaluation of carotid stenosis in patients with acute ischemic stroke by MRI combined with MRA
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摘要: 目的 探讨分析磁共振成像(MRI)联合磁共振血管成像(MRA)评估急性缺血性脑卒中(AIS)患者颈动脉狭窄的应用价值。方法 本研究采用前瞻性分析方法，纳入2019年1月—2022年2月我院100例AIS患者为研究对象。全部患者均先后接受MRI、MRA检查，并于1周内进行数字减影血管造影(DSA)检查。以DSA检查结果为“金标准”，分析MRI联合MRA评估AIS患者颈动脉狭窄的应用价值。结果 100例患者经DSA结果证实，共有118条颈动脉血管存在狭窄，其中31条轻度狭窄，48条中度狭窄，29条重度狭窄，10条完全闭塞，占比分别为26.27%、40.68%、24.58%、8.47%；MRI、MRA单独和二者联合评估AIS患者颈动脉狭窄的准确性分别为72.88%、85.59%、96.61%，且以二者联合评估的准确性最高，差异有统计学意义(P＜0.05)；以病理学检查结果作为依据，MRI联合MRA评估纤维帽、脂质核、伴有出血、伴有钙化形成和斑块软硬度的符合率比较，差异无统计学意义(P＞0.05)。结论 MRI联合MRA评估AIS患者颈动脉狭窄与DSA结果具有较高的一致性，有一定的临床应用价值，且还可分析斑块组成成分，具有独特优势。Abstract: Objective To evaluate the value of magnetic resonance imaging(MRI) combined with magnetic resonance angiography(MRA) in the evaluation of carotid stenosis in patients with acute ischemic stroke(AIS).Methods From January 2019 to February 2022, 100 AIS patients in the hospital were included in this study by prospective analysis. All patients underwent MRI and MRA in order, and digital subtraction angiography(DSA) within 1 week. Taking DSA examination results as the"gold standard", the value of MRI combined with MRA in the evaluation of carotid stenosis in patients with AIS was analyzed.Results The results of DSA showed that 118 carotid arteries in 100 patients had stenosis, including 31 mild stenosis, 48 moderate stenosis, 29 severe stenosis and 10 complete occlusion, accounting for 26.27%, 40.68%, 24.58% and 8.47% respectively; the accuracy of MRI, MRA alone and combined assessment of carotid stenosis in patients with AIS were 72.88%, 85.59% and 96.61% respectively, and the accuracy of combined assessment of MRI and MRA was the highest, and the difference was statistically significant(P < 0.05); based on the results of pathological examination, compared the coincidence rate of MRI combined with MRA in evaluating fibrous cap, lipid core, bleeding, calcification and plaque hardness, there was no statistically significant difference(P > 0.05).Conclusion MRI combined with MRA has high consistency with DSA in the evaluation of carotid stenosis in patients with AIS and certain clinical application value. Meanwhile it can also analyze the composition of plaque, with unique advantages.
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表 1 MRI检查颈动脉狭窄结果
例 MRI检查 DSA检查 合计 轻度狭窄 中度狭窄 重度狭窄 完全闭塞 轻度狭窄 21 7 0 0 28 中度狭窄 10 38 4 0 52 重度狭窄 0 3 21 4 28 完全闭塞 0 0 4 6 10 合计 31 48 29 10 118 Kappa值 0.609 
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表 2 MRA检查颈动脉狭窄结果
例 MRA检查 DSA检查 合计 轻度狭窄 中度狭窄 重度狭窄 完全闭塞 轻度狭窄 27 4 0 0 31 中度狭窄 4 42 2 0 48 重度狭窄 0 2 25 3 30 完全闭塞 0 0 2 7 9 合计 31 48 29 10 118 Kappa值 0.793
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表 3 MRI联合MRA检查颈动脉结果
例 MRI联合MRA检查 DSA检查 合计 轻度狭窄 中度狭窄 重度狭窄 完全闭塞 轻度狭窄 30 0 0 0 30 中度狭窄 1 47 0 0 48 重度狭窄 0 1 28 1 30 完全闭塞 0 0 1 9 10 合计 31 48 29 10 118 Kappa值 0.951
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表 4 MRI联合MRA评估AIS患者颈动脉斑块特征的价值
例 斑块特征 病理学检查 MRI联合MRA 符合率/ 例(%) χ2 P 纤维帽 113 110 110(97.35) 1.351 0.245 脂质核 92 87 87(94.57) 3.289 0.070 伴有出血 61 58 58(95.08) 1.367 0.242 伴有钙化形成 90 88 88(97.78) 0.506 0.477
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表 5 MRI联合MRA评估AIS患者颈动脉斑块软硬度的价值
例(%) 评估方法 软斑块 硬斑块 病理学检查 83(48.26) 89(51.74) MRI联合MRA 80(46.51) 92(53.49) χ2 0.105 P 0.746
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