目的 比较CT血管成像（CT angiography，CTA）与高分辨率磁共振血管壁成像（high-resolution magnetic resonance angiography，HR-MRI）对青年脑卒中动脉夹层的诊断价值。 方法 选择我院2016年1月至2021年12月青年卒中患者70例，通过数字减影血管造影（digital subtraction angiography，DSA）确诊为动脉夹层患者47例和非动脉夹层患者23例，所有患者进行CTA和HR-MRI检查，分析CTA与HR-MRI对青年卒中动脉夹层的诊断率及一致性。采用受试者工作特征曲线（ROC）分析CTA与HR-MRI对青年脑卒中动脉夹层的诊断价值。 结果 与非动脉夹层患者比较，动脉夹层患者年龄更大、头颈疼痛症状者更多（P<0.05）；CTA和HR-MRI对该病的诊断阳性率分别为30.00%（21/70）和48.57%（49/70）；以DSA结果为金标准，CTA和DSA的相关性Kappa=0.458，HR-MRI和DSA的相关性Kappa=0.829，HR-MRI和DSA的一致性较好；采用ROC曲线分析，CTA和HR-MRI对青年卒中动脉夹层的敏感性分别为64.87%和87.68%，特异性分别为80.27%和90.82%，ROC曲线下面积（AUC）分别为0.86和0.95，与CTA的诊断效率相比，HR-MRI的AUC大，其对青年卒中动脉夹层诊断价值较高。 结论 与CTA检查相比，HR-MRI检查对高度怀疑青年脑卒中动脉夹层诊断价值较高。
Abstract
Objective To compare and analyze the diagnostic value of CT angiography (CTA) and high-resolution magnetic resonance angiography (HR-MRI) in young stroke patients with arterial dissection. Methods Seventy young stroke patients diagnosed in our hospital from January 2016 to December 2021 were selected, 47 were diagnosed with arterial dissection by digital subtraction angiography (DSA) and 23 were diagnosed with non-arterial dissection. All patients were performed with CTA and HR-MRI imaging. The diagnostic rate and consistency of CTA and HR-MRI in young stroke patients with arterial dissection were analyzed. The diagnostic value of CTA and HR-MRI in young stroke patients with arterial dissection was analyzed by receiver operating characteristic curve (ROC). Results Compared with non-dissected patients, patients with arterial dissection were older and had more head and neck pain symptom (P<0.05). The positive rate of CTA and HR-MRI for young stroke patients with artery dissection was 30.00%（21/70） and 48.57%（49/70）, respectively. Using DSA as the gold standard, the correlation between CTA and DSA was Kappa 0.458, and the correlation between HR-MRI and DSA was Kappa 0.829, indicating the consistency between HR-MRI and DSA was good. ROC curve analysis showed that the sensitivity of CTA and HR-MRI for young stroke patients with arterial dissection were 64.87% and 87.68%, respectively, the specificity were 80.27% and 90.82%, respectively, and the area under curve (AUC) of ROC were 0.86 and 0.95, respectively. Compared with the diagnostic efficiency of CTA, HR-MRI had a higher AUC. It had high diagnostic value for young stroke patients with arterial dissection. Conclusions Compared with CTA, HR-MRI has higher diagnostic value in highly suspected young stroke patients with arterial dissection.
关键词
CTA /
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HR-MRI /
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脑卒中 /
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动脉夹层 /
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诊断价值
Key words
CTA /
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HR-MRI /
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Stroke /
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Arterial dissection /
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Diagnostic value
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