Comparison Of The Consistency Of MRA And DSA In Evaluating The Stenosis Degree Of Cerebral Artery

BACKGROUND: As a non-invasive cerebral vascular imaging examination,MRA can provide clinical screening for cerebral artery stenosis for patients with ischemic cerebrovascular disease and provide some imaging evidence for further clinical intervention.The previous literature reported that the consistency between MRA and DSA was high,and even arguing that MRA could basically replace DSA as a diagnostic test.However,by observing the results of MRA and DSA examination in our hospital in recent years,we find that the consistency of the two examination results does not seem to be consistent with the reports in the literature.OBJECTIVE: To compare the consistency of cerebral MRA and cerebrovascular DSA in the diagnosis of cerebral artery stenosis.DSA was used as the gold standard to evaluate the reliability of MRA in the diagnosis of cerebral artery stenosis.METHODS: Seventy patients(a total of 770 blood vessels)underwent cranial 1.5 T 3D TOF-MRA and cerebrovascular DSA during hospitalization from January,2013 to February,2018 in the department of neurology.All patients underwent cerebrovascular DSA examination in 1 day to 2 weeks after the completion of cerebrovascular MRA examination.The Kappa test was performed on the MRA and DSA examination results.The Kappa coefficient was calculated by comparing the consistency of MRA and DSA on the diagnosis of cerebral artery stenosis.The sensitivity,specificity,positive predictive value,negative predictive value,Youden index of MRA in evaluating the degree of stenosis of the anterior circulation arteries(bilateral internal carotid artery,bilateral middle cerebral artery,bilateral anterior cerebral artery)and posterior circulation arteries(bilateral vertebral artery,bilateral posterior cerebral artery,bilateral basilar artery)was calculated.RESULTS: 1.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of MRA in the diagnosis of anterior circulation artery without stenosis is 90.8%,81.4%,96.8%,59.3% and 72.2% respectively.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of MRA in the diagnosis of anterior circulation artery with mild stenosis is 50%,97.5%,28.6%,99% and 47.5% respectively.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of MRA in the diagnosis of anterior circulation artery with moderate stenosis is 58.8%,97%,45.4%,98.2% and 55.8% respectively.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of MRA in the diagnosis of anterior circulation artery with severe stenosis is 60%,97%,50%,98% and 57% respectively.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of MRA in the diagnosis of anterior circulation artery with artery occlusion is 100%,98.2%,66.7%,100% and 98.2% respectively。2.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of MRA in the diagnosis of posterior circulation artery without stenosis is 91.3%,83.6%,96.3%,67.1% and 74.9% respectively.The sensitivity,specificity,positive predictive value,negative predictive value,Youden index of MRA in the diagnosis of posterior circulation artery with mild stenosis is 33.3%,98.2%,14.3%,99.4%,31.5% respectively.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of MRA in the diagnosis of posterior circulation artery with moderate stenosis is 50%,97.7%,27.3%,99.1% and 47.7% respectively.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of MRA in the diagnosis of posterior circulation artery with severe stenosis is 72.2%,94.6%,60.5%,96.7% and 66.8% respectively.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of MRA in the diagnosis of posterior circulation artery with artery occlusion is 50%,95.1%,53.3%,97.6% and 45.1% respectively.3.Of all the 420 anterior circulation vessels,a total of 39 vessels included 20 internal carotid arteries,10 middle cerebral arteries and 9 anterior cerebral artery,whose stenosis was overestimated.And 13 vessels’ stenosis was underestimated.All the 13 vessels are internal carotid arteries.Of all the 350 posterior circulation vessels,the stenosis of 28 vessels(including 6 vertebral arteries,1 basilar artery,21 posterior cerebral artery)was overestimated,and the stenosis of 20 vessels which were all vertebral arteries was underestimated..4.The Kappa coefficient for anterior circulation arteries MRA and DSA results is 0.586(P<0.0001),and the Kappa coefficient for posterior circulation arteries MRA and DSA results was 0.595(P<0.0001).CONCLUSION: 1.Our hospital’s MRA examination is more reliable in the diagnosis of anterior circulation artery occlusion lesions,and has strong ability to exclude the diagnosis of anterior and posterior circulation vascular stenosis.The ability of diagnosing mild,moderate,severe stenosis of the anterior circulation artery and the stenosis of all levels of the posterior circulation artery is different from that of DSA.2.There are still some differences in the consistency of MRA examination and DSA examination in the diagnosis of cerebral artery stenosis,and the results are of moderate intensity correlation.MRA can be used as an initial screening method to detect brain artery stenosis.MRA has a strong ability to exclude cerebral stenosis.For patients without brain artry stenosis diagnosed by MRA,DSA examination can be basically avoided.However,it is necessary for patients with mild,moderate,and severe cerebral vascular stenosis diagnosed by MRA to further clarify the degree of cerebral stenosis by DSA examination.