| PartⅠ The primary research of the high resolution magnetic resonance imaging characters in cervicocerebral arterial dissection in 3D volume isotropic spin-echo sequence(3D-VISTA)ObjectivePerform the high resolution magnetic resonance imaging(HRMRI)on patients with cervicocerebral arterial dissection(CCAD)by 3D-VISTA.Aim to a better understanding about CCAD and distinguish the other causes of lumen stenosis by observing the morphological and other characteristics of this disease.Materials and Methods1.SubjectsA total of 36 consecutive patients(46 blood vessels)were enrolled in the department of neurology or neurosurgery from January 2012 to April 2017 in our hospital.The inclusion criterions were as follows:(1)adult patients(ie,older than 18 years),clinically characterized as stroke or TIA and/or neck pain and/or headache;(2)MRA,CTA,DSA or clinically proven or highly suspected that there was a dissection in the cervicocerebral arterial.Collected the patients’ clinical characteristics and the corresponding laboratory tests.All examinations were approved by the patients and the ethics committee,and then the patients signed informed consent.2.Scanning equipments,sequences and parametersAll patients were performed on a Philips 3.0T MRI scanner(Netherlands,Achieva or Ingenial)using a carotid 8-channel phased array surface coil or a standard head and neck 16-channel quadrature coil.Firstly,all patients underwent a 3D TOF MRA scanning to localize the cervicocerebral arteries.Then,3D-VISTA examination were performed on the basis of 3D TOF MRA in a coronal or saggital or axial plane to cover the target vessels.Adjust the scanning angle according to the actual situation,to obtain a multi-dimensional and multi-angle view of the target vessel.The scan sequences and parameters were as follows:(1)3D TOF MRA:TE 3.5 ms,TR 20 ms,slice thickness 1.4 mm,FOV 140 mm×140 mm;(2)T1WI SPAIR VISTA,TE 18 ms,TR 350 ms,slice thickness 1.2 mm,ETL 25,matrix 256×256,FOV 130 mmx 130 mm;(3)T2WI VISTA,TE 135 ms,TR 2000 ms,slice thickness 1.2 mm,ETL 25,matrix 256x256,FOV 130 mm×130 mm.T1WI enhancement was acquired after intravenous injection of Gd-DTPA,in the concentraction of 10%and dose of 0.2 ml/kg.3.Image quality and quantity analysis3.1 The image quality analysisThe image quality of 3D-VISTA and 3D TOF MRA was analysed in a double-bland method by two senior doctors.The cases of motion artifacts,poor image quality which can not display the lumen and wall conditions in 3D-VISTA were excluded.At the same time,the 3D-VISTA images were evaluated independently whether dissection exist.Negotiate to resolve the inconsistent opinions.3.2The image quantity analysisEach sequence of signal reference standard:cervical artery were regard sternocleidomastoid muscle as reference;the intracranial artery were regard near brain parenchyma as reference.Observed the morphology and location of mural hematoma,dissection flaps,double lumen sign,aneurysmal dilatation or dissecting aneurysms.Analyzed the relationship between signal intensity and time of mural hematoma,and calculate the formation time "t"(unit days)of mural hematoma.Results1、A total of 36 cases(46 blood vessels)of CCAD were diagnosed by 3D-VISTA.30 cases were male,6 cases were female.The average age was 46.94 ±12.45 years.6 patients with inducement,6 patients with smoking,5 patients with alcohol addicts and diabetes mellitus respectively,7 patients with hyperlipidemia,12 patients with hypertension,8 patients with hypertonic hemi-tubulinemia.2、In the total 46 vessels,There were 21 blood vessels for extracranial carotid arteries,1 for intracranial carotid arteries,11 for intracranial vertebral arteries,5 for extracranial vertebral arteries,5 for basilar arteries,and 3 for middle cerebral arteries.Eight of the 33 patients involved multiple vessels of intracranial and cervical arteritis.3、Intramural hematoma,double lumen sign,intimal flap,aneurysmal dilatation,false lumen or intramural hematoma along true lumen spiral out of shape were observed in 30,22,25,10 and 16 blood vessels,respectively.The shapes of 6 blood vessels’ intramural hematoma were spotted,19 were crescent,13 were roundlike,and 3 were long strip.4、The formation time of intramural hematoma range from 5 to 180 days,including 3 less than 7 days,2 more than 60 days,and the remaining 25 blood vessel from 7 to 60 days.Conclusions1、3D-VISTA can well present the characteristic signs of cervicocerebral dissection,including the signal,morphology,location and range of the intramural hematoma,double lumen sign,intimal flap,aneurysmal dilatation;2、The morphology of intramural hematoma was closely related to the scanning section.It can be spotted,crescent,round and long strip.The intramural hematoma or false lumen along true lumen spiral out of shape was the characteristic imaging finding of dissection;3、T1WI VISTA with fat suppress technology was high resolution.It’s highly sensitive to intramural hematoma;The signal intensity of intramural hematoma was related to the time of onset.When the time was less than 1 week or more than 2 months,the intramural hematoma was difficult to observe in MRI.4、3D-VISTA can differentiate the stenosis caused by dissection or non-dissection.It can also identify the cause of dissection.PartⅡ Comparison of 3D-VISTA with 3D TOF MRA and DSA in cervicocerebral arterial dissection.ObjectiveComparing with DSA,3D TOF MRA,explore the diagnostic value of 3D-VISTA in cervicocerebral arterial dissection.Materials and Methods1.SubjectsA total of 86 consecutive patients were enrolled in the department of neurology or neurosurgery from January 2012 to December 2016 in our hospital.The inclusion criterions were as follows:(1)adult patients,clinically characterized as stroke or TIA and/or neck pain and/or headache;(2)Suspected or diagnosed with cervicocerebral arterial dissection by MRA,CTA,DSA or clinic.(3)Having DSA,3D TOF MRA check information at the same time.All examinations were approved by the patients and the ethics committee,and then the patients signed informed consent.2.Scanning equipments,sequences and parametersThe equipments,the methods and parameters of 3D-VISTA and 3D TOF MRA were the same as part I.DSA examination:Anti-platelet aggregation drugs were given as routine preoperative administration.Seldinger technology was used to conduct femoral artery cannulation.Systemic heparinization,though the way of vein injection,was necessary after placement of artery sheath.For the first time,the aortic arch and above angiography was operated by using pigtail catheter.Then,5F Sigel bend catheter was used to conduct the main artery and its branches angiography of head and neck.The processing of intubation was fluoroscopically guided.Heparin was neutralized at the end of angiography.We pressed the punctured site locally for 15 minutes and bandaged up.3.3D-VISTA and 3D TOF MRA image quality analysis:in the same way with part I.4.Image analysis and statisticsThe subjects were divided into ICA group,VBA group and MCA group.Vertebral artery was segmented into five segments,the first four segments were known as extracranial segment of vertebral artery,the fifth as intracranial segment.Mural hematoma,dissection flaps,double lumen sign,aneurysmal dilatation or dissecting aneurysms as basis for diagnosis of cervicocerebral arterial dissection on 3D-VISTA and 3D-TOF MRA.DSA is basis on dissection flaps,double lumen sign,aneurysmal dilatation or dissecting aneurysms for diagnosis of dissection.Record the results of 3D-VISTA,3D TOF MRA,3D-VISTA combined with 3D TOF MRA and DSA,counted as dissection,non-dissection or uncertain.All cases were confirm dissection or non-dissection with the final results of clinically diagnostic.5.Statistical methodsAll data were analyzed by SPSS 20.0.(1)analyze the difference between 3D-VISTA,3D TOF MRA,3D-VISTA combined with 3D TOF MRA and DSA in the diagnostic of CCAD by McNemar test;(2)analyze the consistency of 3D-VISTA,3D TOF MRA,3D-VISTA combined with 3D TOF MRA and DSA with clinical final diagnosis,and calculate the Kappa valu.(3)referring to the final results of clinically diagnostic,evaluated the diagnostic efficacy of 3D-VISTA and 3D-VISTA combined with 3D TOF MRA for cervicocerebral arterial dissection,computed the specificity(Sp),sensitivity(Se),negative predictive value(NPV),position predictive value(PPV),diagnose accordance rate(DCR),youden index of ICA group,VBA group and MCA group,respectively.Results1、There were 86 patients(male 74,female 12),113 blood vessels in total,which 3D-VISTA and 3D-TOF MRA images quality meet the requirements.2、The McNemar tests were performed between 3D-VISTA and 3D TOF MRA,3D-VISTA combined with 3D-TOF MRA,DSA in the diagnostic of CCAD,the P values were 0.00,0.17,0.01,respectively.The P values of the McNemar tests between 3D TOF MRA and 3D-VISTA combined with 3D-TOF MRA,DSA were 0.00,0.83,respectively.The P value of the McNemar tests between 3D-VISTA combined with 3D TOF MRA and DSA was 0.00.3.Referring to the final results of clinically diagnostic,the Kappa values of 3D-VISTA,3D TOF MRA,3D-VISTA combined with 3D TOF MRA,DSA in diagnostic of CCAD were 0.89,0.62,0.94,0.53,respectively.4、Referring to the final results of clinically diagnostic,the Sp,Se,NPV,PPV,DCR and Youden index of 3D-VISTA in evaluating the dissection of ICA group were 100%,94.74%,96.67%,100%,97.92%,94.74%respectively;The Sp,Se,NPV,PPV,DCR and Youden index of VBA group were 100%,90.48%,93.94%,100%,96.15%,90.48%respectively;The Sp,Se,NPV,PPV,DCR and Youden index of MCA gourp were 100%,100%,100%,100%,100%,100%respectively.5、In ICA group,The Sp,Se,NPV,PPV,DCR and Youden index of 3D-VISTA combined with 3D TOF MRA in evaluating dissection were 100%,94.74%,96.67%,100%,97.92%,94.74%respectively;In VBA group were 100%,100%,100%,100%,100%,100%respectively;In MCA gourp were 100%,66.67%,90.91%,100%,92.31%,66.67%respectively.Conclusions1、3D-VISTA can diagnose cervicocerebral arterial dissection accurately.2、DSA as a traditional "gold standard" in diagnostic of vascular diseases,compared with clinical final diagnosis,the consistency was general.3、In the diagnosis of cervicocerebral arterial dissection,3D-VISTA were more accurate than 3D TOF MRA and DSA.3D-VISTA combined with 3D TOF MRA can improve the diagnostic accuracy.4、In MCA group,the diagnostic capabilities of 3D-VISTA was superior to ICA and VBA groups.In VBA group,the diagnostic capabilities of 3D-VISTA when combined with 3D TOF MRA was superior to ICA and MCA group.5、For those cases which other imaging examination can not confirm the diagnosis of dissection,the 3D-VISTA scan of target blood vessel was recommended to improve the correct rate of diagnosis. |
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