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目的:探讨磁共振血管成像(MRA)诊断儿童烟雾病(MMD)的价值。方法:选择在我院住院1周内,进行脑MRA和数字减影血管造影(DSA)检查的儿童MMD 58例。采用磁共振成像系统行三维时间飞跃法(3D-TOF)检查,以最大密度投影法(MIP)进行血管图像重建。以双侧颈内动脉C1段(ICA C1)、大脑前动脉A1段(ACA A1)、大脑中动脉M1段(MCA M1)、大脑后动脉P1段(PCA P1)为目标血管,由2名放射科主任或副主任医师结合所有患儿目标血管的3DTOF MRA,对血管狭窄或闭塞情况独立进行判读,将MRA检查结果与同期DSA检查结果进行比较。结果:(1)本组诊断目标血管464支,其中,MRA检查阴性102支,阳性362支(血管闭塞261支、狭窄101支);DSA检查阴性125支,阳性339支(血管闭塞213支、狭窄126支)。以DSA检查结果为标准,MRA检查的阳性预测值、阴性预测值、敏感度、特异性及准确度分别为88.4%、82.4%、94.4%、67.2%和87.1%。(2)MRA诊断的准确度以右侧ACA A1最高,达94.8%;左侧MCA M1次之,达93.1%;左侧ICA C1为86.2%;左侧PCA P1最低,仅为75.9%。诊断ACA A1、MCA M1异常的敏感度最高,达96.2%～100.0%;ICA C1次之,达92.2%～95.9%。剔除PCA P1影响后,MRA诊断颅内大血管异常的准确度达85.0%～94.8%,显著低于DSA检查(P<0.05)。结论:MRA检查在发现对MMD具有诊断有意义的目标血管异常方面的敏感度高,是诊断儿童MMD的有效方法之一,可进行儿童MMD、MMD高危人群和疑诊病例早期筛查,但不能替代DSA检查。
Objective: To investigate the value of magnetic resonance angiography (MRA) in the diagnosis of childhood moyamoya disease (MMD). METHODS: Fifty-eight children with MMD undergoing brain MRA and DSA examinations within 1 week of hospital stay were enrolled. Three-dimensional time-of-flight (3D-TOF) examinations were performed with a magnetic resonance imaging system to reconstruct the blood vessel images with maximum density projection (MIP). The ICA C1, ACA A1, MCA M1 and PCA P1 of the bilateral internal carotid arteries were selected as the target vessels. The Chief or Associate Chief Physician combined the 3DTOF MRA of all the target vessels of the child to interpret the vessel stenosis or occlusion independently and compare the results of the MRA and the results of the DSA in the same period. Results: (1) 464 blood vessels were diagnosed in this group, of which 102 were MRA negative, 362 were positive, 261 were vascular occlusion and 101 were stenosis; 125 were negative by DSA, 339 were positive by DSA, Narrow 126). According to the results of DSA, the positive predictive value, negative predictive value, sensitivity, specificity and accuracy of MRA were 88.4%, 82.4%, 94.4%, 67.2% and 87.1% respectively. (2) The accuracy of MRA diagnosis was highest in ACA A1 on the right side (94.8%), followed by MCA M1 on the left (93.1%), ICA C1 on the left (86.2%) and PCA P1 on the left (75.9%). The sensitivity of diagnosing ACA A1 and MCA M1 was the highest (96.2% -100.0%), followed by ICA C1 (92.2% -95.9%). After excluding the influence of PCA P1, the accuracy of MRA in diagnosing intracranial major vessel abnormalities was 85.0% -94.8%, which was significantly lower than that of DSA (P <0.05). CONCLUSIONS: The high sensitivity of MRA in detecting targeted vascular abnormalities with diagnostic significance for MMD is one of the effective methods for the diagnosis of MMD in children. It can be used for early screening of MMD, MMD at risk and suspected cases in children, but not Alternative DSA check.