Accuracy of Inhance 3D Velocity-Based Magnetic Resonance Phase Contrast Venography in Intracranial Venous Steno-occlusive Disease

三維磁振相位對比靜脈攝影評估顱內靜脈阻塞疾病之準確性

張秀寧(Hsiu-Ning Chang) ； 廖贊傑(Tsan-Chieh Liao) ； 許敦韋(Tun-Wei Hsu) ； 李達彬(Ta-Pin Lee) ； 顏玉樹(Yu-Shu Yen) ； 吳秀美(Hsiu-Mei Wu) ； 范源洪(Yuan-Hong Fan) ； 洪聖哲(Sheng-Che Hung) ； 凌憬峰(Jiing-Feng Lirng)

《臺灣醫事放射期刊》 5卷1期 (2017/03) Pp. 20-30

https://doi.org/10.6717/JTMRT.201703_5(1).0004

摘要

Phase contrast magnetic resonance venography (PC-MRV) can image intracranial veins without administration of contrast agent, but the conventional PC-MRV is not widely used because of the long scanning time. The aim of this study was to evaluate the accuracy of Inhance 3D Velocity-based MRV (Inhance-MRV), a recently developed, optimized phase-contrast pulse sequence, in comparison with that of contrast-enhanced MRV (CE-MRV) for assessing intracranial venous steno-occlusive disease. Eighteen consecutive patients referred for presurgical evaluation of meningiomas or skull base tumor s underwent Inhance-MRV and CE-MRV in a 3T MR scanner. Two experienced radiologists individually scored the stenotic grades of the venous segments on a five-point scale and another rater measured the venous diameters. The intraclass correlation coefficient of interobserver agreement of the stenotic scores was 0.725. In the segment-based analysis, the sensitivity and specificity of Inhance-MRV (≥ 50% stenosis) was 94.4% and 83.3% in all venous segments, and 100% and 87.2% in major venous segments. False positive cases that Inhance-MRV exaggerated venous stenosis are much more common (n = 19) than false negative case (n = 1). The most common locations of disconcordant findings occur in the inferior sagittal sinus (8/18, 44.4%) and transverse sinuses (7/36, 19.4%). Inhance-MRV can provide fast and high-resolution non-contrast magnetic venography. It has high sensitivity and specificity for diagnosing intracranial venous stenosis. However, it inherently tends to underestimate vessel diameters and overestimate stenotic grades. Therefore, the radiologists should be familiar with the common locations of false positive findings to avoid misdiagnosis.

關鍵字

Phase contrast ； magnetic resonance venography ； venous stenosis

並列摘要

相位對比磁振靜脈造影(PCMRV)可以不需施打對比劑即得到顱內血管的影像，但是受限於掃描時間較長，並未得到廣泛的應用。Inhance-MRV 為近來新發展之相位對比磁振靜脈造影，以三維方法取像、並能縮短時間。此研究目的在於評估 Inhance-MRV 和傳統施打對比劑之 Contrast-enhanced MRV(CE-MRV)在顱內靜脈狹窄之準確度差異。收集18位顱內腫瘤術前病患，在3 Tesla 磁振造影下，施行Inhance-MRV 和 CEMRV，並由兩位有經驗的放射線醫師各自於靜脈各部位以五分法評估狹窄程度，並計算靜脈直徑。兩位醫師評估之組內相關係數(ICC)為 0.725。於≧50％狹窄部位，Inhance-MRV 之敏感度和特異性於所有靜脈部位分別為94.4％和83.3％；於主要靜脈部位分別為100％和 87.2％。而 Inhance-MRV 增加狹窄程度的偽陽性數目(n=19)較偽陰性數目(n=1)常見許多。差異最大的部位在下矢狀靜脈竇(8/18,44.4％)和橫竇(7/36,19.4％)。Inhance-MRV 可以提供快速、高解析度、不需施打對比劑之磁振血管造影，並對於診斷顱內靜脈狹窄有著高敏感度及高特異性。但是本質上容易低估血管管徑並高估狹窄程度，所以放射線醫師需注意容易偽陽性部位，並避免誤診。

並列關鍵字

相位對比 ； 磁振靜脈造影 ； 靜脈狹窄