İnternal Karotid Arter Darlıklarında Time-Resolved Kontrastlı Manyetik Rezonans Anjiyografi ve Dijital Substraksiyon Anjiyografinin Karşılaştırılması

Year 2017, Volume: 7 Issue: 3, 208 - 216, 07.11.2017

Erkan Gökçe

https://doi.org/10.16899/gopctd.349805

Abstract

Amaç: Bu çalışmada, inme ve serebrovasküler hastalık semptomları olan hastalarda internal karotid arter darlığını saptamada, dijital substraksiyon anjiyografi (DSA) referans alınarak TRICKS MRA tekniğinin duyarlılık, özgüllük, olumlu ve olumsuz öngörü değerleri ve tanısal doğruluğu araştırılmıştır.

Materyal ve Metodlar: Bu çalışmaya, Nisan 2009-Kasım 2010 tarihleri arasında, toplam 22 (16 erkek, 6 kadın) olgu dahil edilmiştir. MRA incelemeleri, 1.5 Tesla MR görüntüleme sisteminde yapılmıştır. Her olgunun MRA ve DSA görüntüleri, birbirinden bağımsız iki radyolog tarafından değerlendirilmiştir. İCA stenoz oranı NASCET yöntemine göre sagittal plandaki MR anjiyografik maksimum yoğunluk projeksiyonları ve lateral plandaki DSA görüntüleri üzerinden saptanmıştır. 

Bulgular: Tüm segmentleri boyunca 44 İCA, TRICKS MRA ve DSA ile 56 stenoz noktasında karşılaştırıldı. Gözlemciler arası uyum k istatistiğine göre her iki yöntem için de çok iyi ve mükemmel düzeyde olup TRICKS MRA için 0.73 ve DSA için 0.83’dür. TRICKS MRA’nın %70-99 aralığında stenozu öngörmede birinci ve ikinci gözlemciye göre duyarlılığı; %100 ve %100, özgüllüğü  %92,3 ve %94,2, PPV %50 ve %50, NPV %100 ve %100 olarak saptanmıştır.

Sonuç: ICA stenozlarının saptanmasında yüksek tanısal doğruluk oranlarıyla TRICKS MRA’nın, komplikasyon riski yüksek, invaziv bir yöntem olan DSA’ya alternatif olarak kullanılabileceği düşünülmektedir.

Keywords

Dijital subtraksiyon anjiografi, İnternal karotid arter stenozu, Zaman-çözünürlü kontrastlı manyetik rezonans anjiografi

Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography Versus Digital Subtraction Angiography in Internal Carotid Artery Stenosis

Abstract

Objectives: In this study, digital subtraction angiography (DSA) being taken as a reference, the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and diagnostic accuracy of time-resolved imaging of contrast kinetics magnetic resonance angiography (TRICKS MRA) was used in the detection of ICA stenosis in patients with stroke and cerebrovascular disease symptoms.

Materials and methods: From April 2009 to November 2010, 22 (16 male, 6 female) consecutive patients were included in this study. MRA was performed 1.5 Tesla MR. Results of TRICKS MRA, and DSA were read independently by two observers. ICA stenosis was measured according to the following North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. From the MR angiographic maximum intensity projections (MIP), the percentage of ICA stenosis was assessed on sagittal projection, which coincided with the lateral of the DSA projections used.

Results: All segments throughout in 44 ICA’s compared at 56 point of stenosis in TRICKS MRA and DSA. The k statistics that reflected the interobserver variability between observers 1 and 2 were very good and similar for two tests: 0.73 for TRICKS MRA, and 0.83 for DSA. In the 70-99% carotid artery stenosis range, according to first and second independent observation, TRICKS MRA has a sensitivity of 100% and 100%; specificity of 92.3% and 94.2%; PPV of 50% and 50%, NPV of 100% and 100%, respectively, compared to digital subtraction angiography.

Conclusion: TRICKS MRA which has high rates of diagnostic accuracy on determining ICA stenoses could be considered as an alternative for invasive DSA which has higher risk of complications.

Keywords

Digital subtraction angiography, Internal carotid artery stenosis, Time-resolved contrast-enhanced magnetic resonance angiography

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