磁共振3D-TOF与PETRA序列在颅脑血管疾病中诊断价值的对比研究

Comparative Study on the Diagnostic Value of Magnetic Resonance 3D-TOF and PETRA Sequences in Cerebrovascular Diseases

摘要: 深度对比三维时间飞跃法磁共振血管成像(3D-TOF-MRA)与纯血池快速成像(PETRA-MRA)序列在颅脑血管疾病中的图像质量、血管树精细分支显示能力及临床诊断效能，明确两种无创血管成像技术的应用优势与局限性，为颅脑血管疾病的精准无创诊断及序列合理选择提供参考依据。方法：回顾性选取2023年1月~2025年12月本院收治的疑似颅脑血管疾病患者286例，所有受试者均于7 d内完成3D-TOF-MRA、PETRA序列扫描及数字减影血管造影(DSA)检查。以DSA为金标准，由2名副主任医师采用双盲法独立阅片，对比两种序列的客观图像质量指标、主观评分及颅内动脉1~5级血管分支显示率，统计对颅内动脉狭窄、动脉瘤、动静脉畸形(AVM)、硬脑膜动静脉瘘(DAVF)的检出情况，计算诊断敏感性、特异性、准确率及AUC值，评估诊断一致性，并记录检查耗时与安全性。结果显示，PETRA序列的颅脑血管与背景组织CNR、信号强度比均显著高于3D-TOF-MRA，信号均匀度显著更优，两组SNR无统计学差异。PETRA序列主观图像质量评分、医师诊断一致性Kappa值、颅内5级血管分支显示率均显著高于3D-TOF-MRA。诊断效能方面，PETRA序列对颅脑血管疾病的整体诊断准确率、敏感性、特异性及AUC均显著高于3D-TOF-MRA。亚组分析显示，PETRA对颈内动脉虹吸段重度狭窄、直径 < 3 mm微小动脉瘤、AVM引流静脉及DAVF瘘口的检出率 ≥ 93%，远高于3D-TOF-MRA的60.0%~71.9%；而两种序列对颅内大血管主干中重度狭窄的检出率无统计学差异。两种序列均无需对比剂，无严重不良事件，PETRA扫描耗时更短，患者耐受度更优。结论：磁共振PETRA序列在颅脑血管精细解剖显示、微小病变及复杂血流病变诊断中优势明显，综合效能优于3D-TOF-MRA，可作为复杂病变术前评估、微小病变筛查及疑难病例确诊的优选无创成像方式。3D-TOF-MRA操作简便、成本低廉，更适用于常规初筛、健康体检及基层医院应用。临床无需固定选用单一序列，应结合诊疗需求、病变类型、血管部位及设备条件个体化选择，必要时联合应用以提升诊断精准性与高效性。

Abstract: To compare the image quality, fine branch display ability of vascular tree, and clinical diagnostic efficacy of 3D-TOF-MRA and PETRA-MRA sequences in cerebral vascular diseases, and to clarify the application advantages and limitations of the two non-invasive vascular imaging techniques, providing reference for accurate non-invasive diagnosis and rational sequence selection of cerebral vascular diseases. Method: A retrospective study was conducted on 286 suspected patients with cerebrovascular disease admitted to our hospital from January 2023 to December 2025. All subjects completed 3D-TOF-MRA, PETRA sequence scanning, and digital subtraction angiography (DSA) examination within 7 days. Using DSA as the gold standard, two associate chief physicians independently reviewed the images using a double-blind method to compare the objective image quality indicators, subjective scores, and display rates of 1~5 grade intracranial artery branches between two sequences. The detection of intracranial artery stenosis, aneurysms, arteriovenous malformations (AVMs), and dural arteriovenous fistulas (DAVF) was statistically analyzed, and diagnostic sensitivity, specificity, accuracy, and AUC values were calculated to evaluate diagnostic consistency. The examination time and safety were recorded. The results showed that the cerebral blood vessel to background tissue CNR and signal intensity ratio of PETRA sequence were significantly higher than those of 3D-TOF-MRA, and the signal uniformity was significantly better. There was no statistical difference in SNR between the two groups. The subjective image quality score, physician diagnostic consistency Kappa value, and intracranial 5-level vascular branch display rate of PETRA sequence were significantly higher than those of 3D-TOF-MRA. In terms of diagnostic efficacy, PETRA sequence has significantly higher overall diagnostic accuracy, sensitivity, specificity, and AUC for cerebrovascular diseases than 3D-TOF-MRA. Subgroup analysis showed that PETRA had a detection rate of ≥ 93% for severe stenosis of the internal carotid artery siphon segment, small aneurysms with a diameter < 3 mm, AVM draining veins, and DAVF fistulas, which was much higher than the 60.0%~71.9% of 3D-TOF-MRA; There was no statistically significant difference in the detection rate of moderate to severe stenosis in the main trunk of intracranial large blood vessels between the two sequences. Both sequences do not require contrast agents, have no serious adverse events, have shorter PETRA scanning time, and have better patient tolerance. Conclusion: Magnetic resonance PETRA sequence has significant advantages in fine anatomical display of cranial blood vessels, diagnosis of small lesions and complex blood flow lesions, and its comprehensive efficacy is superior to 3D-TOF-MRA. It can be used as the preferred non-invasive imaging method for preoperative evaluation of complex lesions, screening of small lesions, and diagnosis of difficult cases. 3D-TOF-MRA is easy to operate, cost-effective, and more suitable for routine screening, health check ups, and primary hospital applications. Clinical practice does not require a fixed selection of a single sequence, and individualized selection should be made based on diagnosis and treatment needs, lesion types, vascular locations, and equipment conditions. When necessary, combined applications can be used to improve diagnostic accuracy and efficiency.