CT angiography and magnetic resonance angiography visually showing spinal vessels and spinal involvement in diagnosing spinal vascular malformations
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摘要:
目的 研究CT血管造影（CTA）与磁共振血管成像（MRA）诊断脊髓血管畸形的临床应用。 方法 本研究为前瞻性研究，以2020年2月~2022年12月在我院诊断并进行治疗的脊髓血管畸形患者30例作为试验组，另选取30例同期进行椎体MR平扫加增强的无脊髓血管畸形患者作为对照组，对所有入组对象行磁共振对比增强血管造影（CE-MRA）序列以及重建脊髓血管CTA检查。比较CE-MRA序列以及重建脊髓血管CTA检查的诊断一致性，分析CE-MRA序列以及重建脊髓血管CTA检查联合诊断效能。 结果 CE-MRA以及CTA检查中硬脊膜动静脉瘘、脊髓动静脉畸形、髓周动静瘘之间的差异无统计学意义（P > 0.05），在对瘘口显示情况的分析中，CE-MRA以及CTA检查中对于供血动脉以及瘘口显示情况的差异无统计学意义（P > 0.05）；CE-MRA与金标准的检查一致性较好，Kappa值为0.758；CTA与金标准的检查一致性较好，Kappa值为0.881，CE-MRA以及CTA检查联合诊断的敏感度高于单独检测；ROC曲线分析显示，CE-MRA以及CTA检查联合诊断的曲线下面积高于单独检测（P < 0.001）。 结论 在对脊髓血管畸形患者的诊断中，CTA以及CE-MRA的联合诊断可显著提升患者的诊断效能，可作为临床诊断的重要依据。 -
关键词:
- 脊髓血管畸形 /
- CT血管造影 /
- 磁共振对比增强血管造影 /
- 联合诊断
Abstract:Objective To explore the clinical application of CT angiography (CTA) and magnetic resonance angiography (MRA) in the diagnosis of spinal cord vascular malformations. Methods This prospective study included 30 patients with spinal cord vascular malformation diagnosed and treated in our hospital from February 2020 to December 2022 as the experimental group. In addition, 30 patients without spinal vascular malformation who underwent vertebra MR Scan plus enhancement were selected as the control group. Contrast enhanced magnetic resonance angiography (CE-MRA) sequence and reconstructed spinal vascular CTA were performed on all enrolled subjects. The diagnostic consistency of CE-MRA sequence and reconstructed spinal vascular CTA was compared, and the combined diagnostic efficacy of CE-MRA sequence and reconstructed spinal vascular CTA was analyzed. Results There was no statistical significance in dural arteriovenous fistula, spinal arteriovenous malformation, and perimedullary arteriovenous fistula in CE-MRA and CTA examination (P > 0.05). In the analysis of fistula, there was no statistical significance in the display of supplying artery and fistula in CE-MRA and CTA examination (P > 0.05). CE-MRA had a good consistency by compare with the gold standard, with a kappa value of 0.758, and CTA had a good consistency by compare with the gold standard, with a kappa value of 0.881. The sensitivity of CE-MRA and CTA combined diagnosis were significantly higher than that of the single detection. ROC curve analysis showed that the area under the curve of CE-MRA and CTA combined diagnosis was significantly higher than that of single detection(P < 0.001). Conclusion In the diagnosis of spinal cord vascular malformations, the combined diagnosis of CTA and CE-MRA can significantly improve the diagnostic efficiency of patients, and can be used as an important basis for clinical diagnosis. -
图 1 脊髓血管畸形的3D-CE-MRA图像分析
Figure 1. 3D-CE-MRA image analysis of spinal vascular malformations. Obviously thickened and tortuous drainage vein in thoracic vertebral canal, fistula and blood supplying artery could be seen on the right side at T11-12 level.
图 2 脊髓血管畸形的伪彩图
Figure 2. False-color images of vascular malformations in the spinal cord. Orifice fistula and blood supplying artery can be seen on the right side at T11-12 level.
表 1 试验组以及对照组的一般资料以及慢性病情况比较
Table 1. Comparison of general data and chronic diseases between the experimental group and the control group (n=30)
Group Gender(n, Male/Female) Age (years, Mean±SD) BMI (kg/m2, Mean±SD) Hypertension [n(%)] Diabetes [n(%)] Dyslipemia [n(%)] Experimental group 12/18 45.26±1.02 24.27±2.65 15(50.00) 9(30.00) 11(36.67) Control group 14/16 45.30±1.51 24.30±1.96 12(40.00) 10(33.33) 12(40.00) χ2/t 0.271 0.120 0.050 0.606 0.077 0.071 P 0.602 0.905 0.960 0.436 0.781 0.791 
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表 2 CE-MRA以及CTA检查的一致性分析
Table 2. Consistency analysis of CE-MRA and CTA tests (n=30)
Examination method Classification of disease Display of fistula Dural arteriovenous fistula Spinal cord arteriovenous malformation Perimedullary static fistula Supplying artery display Fistula display CE-MRA 12(40.00) 13(43.33) 5(16.67) 28(93.33) 29(96.67) CTA 15(50.00) 11(36.67) 4(13.33) 29(96.67) 27(90.00) χ2 0.611 0.350 1.071 P 0.737 0.554 0.301 CE-MRA: Contrast enhanced magnetic resonance angiography; CTA: CT angiography.
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表 3 CE-MRA与金标准的检查一致性分析
Table 3. Consistency analysis of CE-MRA and gold standard (n)
Index Gold standard + - CE-MRA + 25 4 - 5 26 Kappa 0.758
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表 4 CTA与金标准的检查一致性分析
Table 4. Analysis of consistency between CTA and gold standard (n)
Index Gold standard + - CTA + 24 3 - 6 27 Kappa 0.881
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表 5 CE-MRA以及CTA检查单独检测与联合检测的诊断效能比较
Table 5. Comparison of the diagnostic efficacy of CE-MRA and CTA tests by single detection and combined detection
Diagnostic method Number of true positive (n) Number of false positive (n) Number of true negative (n) Number of false negative (n) Accuracy rate (%) Sensitivity (%) Specificity (%) Positive predictive value (%) Negative predictive value (%) CE-MRA 25 21 9 5 56.67 83.33 30.00 54.35 64.29 CTA 24 20 10 6 56.67 80.00 62.50 54.55 62.50 Combined diagnosis 27 5 25 3 86.67 90.00 89.29 84.38 89.29
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表 6 ROC曲线分析
Table 6. ROC curve analysis
Diagnostic method Standard error AUC AUC（95% CI） P CE-MRA 0.027 0.778 0.762-0.869 < 0.001 CTA 1.027 0.792 0.762-0.870 < 0.001 Combined diagnosis 2.027 0.832 0.760-0.871 < 0.001
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