A three-dimensional (3D) cardiovascular magnetic resonance (CMR) vessel wall imaging (VWI) technique based on 3D T1 weighted (T1w) Sampling Perfection with Application-optimized Contrast using different flip angle Evolutions (SPACE) has recently been used as a promising CMR imaging modality for evaluating extra-cranial and intra-cranial vessel walls. However, this technique is yet to be validated against the current diagnostic imaging standard. We therefore aimed to evaluate the diagnostic performance of 3D CMR VWI in characterizing carotid disease using intra-arterial digital subtraction angiography (DSA) as a reference. Consecutive patients with at least unilateral > 50% carotid stenosis on ultrasound were scheduled to undergo interventional therapy were invited to participate. The following metrics were measured using 3D CMR VWI and DSA: lumen diameter of the common carotid artery (CCA) and segments C1–C7, stenosis diameter, reference diameter, lesion length, stenosis degree, and ulceration. We assessed the diagnostic sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve of 3D CMR VWI, and used Cohen’s kappa, the intraclass correlation coefficient (ICC), and Bland-Altman analyses to assess the diagnostic agreement between 3D CMR VWI and DSA. The ICC (all ICCs ≥0.96) and Bland-Altman plots indicated excellent inter-reader agreement in all individual morphologic measurements by 3D CMR VWI. Excellent agreement in all individual morphologic measurements were also found between 3D CMR VWI and DSA. In addition, 3D CMR VWI had high sensitivity (98.4, 97.4, 80.0, 100.0%), specificity (100.0, 94.5, 99.1, 98.0%), and Cohen’s kappa (0.99, 0.89, 0.84, 0.96) for detecting stenosis > 50%, stenosis > 70%, ulceration, and total occlusion, respectively, using DSA as the standard. The AUC of 3D CMR VWI for predicting stenosis > 50 and > 70% were 0.998 and 0.999, respectively. The 3D CMR VWI technique enables accurate diagnosis and luminal feature assessment of carotid artery atherosclerosis, suggesting that this imaging modality may be useful for routine imaging workups and provide comprehensive information for both the vessel wall and lumen.

中文翻译：

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使用三维心血管磁共振血管壁成像评估颈动脉粥样硬化疾病：与数字减影血管造影的比较。


基于 3D T1 加权 (T1w) 采样完美和使用不同翻转角演化 (SPACE) 的应用优化对比度的三维 (3D) 心血管磁共振 (CMR) 血管壁成像 (VWI) 技术最近被用作一种有前途的技术用于评估颅外和颅内血管壁的 CMR 成像方式。然而，该技术尚未根据当前的诊断成像标准进行验证。因此，我们旨在以动脉内数字减影血管造影 (DSA) 作为参考，评估 3D CMR VWI 在表征颈动脉疾病方面的诊断性能。连续超声检查显示至少单侧> 50%颈动脉狭窄并计划接受介入治疗的患者被邀请参加。使用 3D CMR VWI 和 DSA 测量以下指标：颈总动脉 (CCA) 和 C1-C7 段的管腔直径、狭窄直径、参考直径、病变长度、狭窄程度和溃疡。我们评估了 3D CMR VWI 的诊断敏感性、特异性、准确性和受试者工作特征 (ROC) 曲线，并使用 Cohen's kappa、组内相关系数 (ICC) 和 Bland-Altman 分析来评估 3D CMR VWI 之间的诊断一致性和DSA。 ICC（所有 ICC ≥0.96）和 Bland-Altman 图表明 3D CMR VWI 的所有个体形态学测量均具有良好的读者间一致性。 3D CMR VWI 和 DSA 之间的所有个体形态学测量也具有极好的一致性。此外，3D CMR VWI 具有高敏感性（98.4、97.4、80.0、100.0%）、特异性（100.0、94.5、99.1、98.0%）和 Cohen's kappa（0.99、0.89、0.84、0.99）。96）以DSA为标准，分别检测狭窄> 50%、狭窄> 70%、溃疡和完全闭塞。 3D CMR VWI 预测狭窄 > 50 和 > 70% 的 AUC 分别为 0.998 和 0.999。 3D CMR VWI 技术能够对颈动脉粥样硬化进行准确诊断和管腔特征评估，表明这种成像方式可用于常规成像检查，并提供血管壁和管腔的全面信息。