烟雾病血管病变颅内血管壁MRI：DANTE-SPACE与常规SPACE对比

BACKGROUND AND PURPOSE: To compare the image quality, wall enhancement characteristics, and presence of artifacts between delay-alternating-with-nutation-for-tailored-excitation blood suppressed prepared (DANTE-SPACE) and conventional sampling-perfection-with-application-optimized-contrasts (SPACE) for post-contrast 3D T1-weighted (T1w) intracranial vessel wall MRI (IVW) in Moyamoya vasculopathy (MMV) patients.

METHODS: 31 subjects who underwent both DANTE-SPACE and SPACE postcontrast 3D T1w during the same IVW scanning session were included. Two neuroradiologists blinded to the acquisition types evaluated qualitative imaging features including overall image quality, signal-to-noise (SNR), severity of artifacts, arterial and venous suppression, and lesion assessment using Likert scales on DANTE-SPACE and SPACE images. Quantitative wall SNR and contrast-to-noise ratio (CNR) were determined for affected sides on both sequences. Intensity of post-contrast enhancement was also qualitatively assessed. Quantitative contrast enhancement (CE) metrics were derived from the CE map generated with the multi-contrast, multi-planar framework (MOCHA) software. Comparative analyses used permutation tests matched to the data type. Interobserver agreement was assessed using two-way random-effects intraclass correlation coefficients (ICCs).

RESULTS: DANTE-SPACE showed significantly reduced arterial (median 1 [IQR 1-1] versus 2 [1-2], P<.001) and venous flow artifacts (1 [1-1] versus 2 [2-3], P<.001) compared with SPACE. Overall image quality did not differ significantly between sequences (P=0.07), nor did qualitative SNR (P=0.99), artifacts (P=0.09), lesion assessment (P=0.32), quantitative wall SNR (P=0.56), or CNR (P=0.19). DANTE-SPACE showed significantly less enhancement in the segment distal to the steno-occlusion compared to SPACE (no enhancement: 83.3% vs 44.0%, P<.001), while the steno-occlusive segment enhancement was similar (P=0.07). Quantitative CE metrics were comparable between sequences (all P>.05).

CONCLUSION: DANTE blood suppression on post-contrast 3D T1w SPACE IVW can significantly reduce arterial and venous flow artifacts and distal slow flow pseudo-enhancement in MMV patients relative to conventional SPACE IVW, without altering lesion enhancement characteristics. DANTE-SPACE incorporated into routine IVW protocols may reduce artifacts that can lead to interpretation errors without altering lesion enhancement assessment.