高分辨血管壁MRI与能谱CT鉴别颅内动脉闭塞病因：斑块 vs 血栓
该回顾性研究纳入108例脑梗死伴颅内动脉闭塞患者，比较HR-VWI与能谱CT鉴别斑块与血栓的效能。两者总体准确率相当（90.74% vs 94.44%），但HR-VWI诊断斑块敏感性更高（100% vs 86.96%），能谱CT诊断血栓敏感性更高（100% vs 84.62%）。能谱CT定量参数nIC、Zeff、λHU在斑块组显著高于血栓组，nIC诊断效能最佳（AUC=0.9355）。
要点
- HR-VWI与能谱CT总体诊断准确率相当，可互补用于闭塞病因鉴别。
- HR-VWI诊断斑块闭塞敏感性100%，能谱CT诊断血栓闭塞敏感性100%。
- 能谱CT的nIC对斑块与血栓鉴别AUC达0.9355，为最佳定量指标。
诊断标准与关键数值
- HR-VWI诊断斑块闭塞敏感性100%，能谱CT为86.96%。
- 能谱CT诊断血栓闭塞敏感性100%，HR-VWI为84.62%。
- HR-VWI总体准确率90.74%，能谱CT总体准确率94.44%。
- 能谱CT定量参数nIC、Zeff、λHU在斑块组显著高于血栓组（均p<0.05），nIC的AUC=0.9355。
局限性
- 回顾性研究设计。
- 单中心研究。
- 样本量有限（108例）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: The etiology of intracranial arterial occlusion (plaque vs. thrombus) dictates treatment but is challenging to determine using conventional imaging. We aimed to compare the diagnostic performance of high-resolution vessel wall magnetic resonance imaging (HR-VWI) and spectral CT (SCT) for this differentiation.
METHODS: This retrospective study included 108 patients with cerebral infarction and intracranial arterial occlusion, classified into an HR-VWI group (n = 54) and an SCT group (n = 54) based on the first-line imaging modality. Using postoperative histopathology or multidisciplinary clinical consensus as the reference standard, the diagnostic performances of both techniques in differentiating plaque from thrombotic occlusion were compared. The quantitative parameters of SCT were analyzed.
RESULTS: The overall diagnostic accuracy of HR-VWI and SCT was comparable (90.74% vs. 94.44%). However, they exhibited complementary diagnostic strengths: HR-VWI demonstrated higher sensitivity in diagnosing plaque occlusion (100% vs. 86.96%), whereas SCT showed superior sensitivity in diagnosing thrombotic occlusion (100% vs. 84.62%). Quantitative analysis of SCT revealed that the standardized iodine concentration (nIC), effective atomic number (Zeff), and energy spectrum curve slope (λHU) in the plaque occlusion group were significantly higher than those in the thrombotic occlusion group (all p < 0.05), with nIC exhibiting the best diagnostic efficacy (AUC = 0.9355).
CONCLUSIONS: HR-VWI and SCT are highly accurate and complementary for determining occlusion etiology. HR-VWI excels in plaque characterization, whereas SCT, with rapid acquisition and quantitative biomarkers like nIC, is advantageous for thrombus identification in acute settings.
引用
- Jia L, Li X, Zhang Y, et al. High-resolution vessel wall MRI and spectral CT in intracranial arterial occlusion: comparative diagnostic performance for plaque vs. thrombus. Neuroradiology. 2026. PMID: 42068360. doi:10.1007/s00234-026-04014-8
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。