3D-T1WI-MATRIX技术在下肢深静脉血栓中的应用价值
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摘要
目的探讨磁共振调制反转角成像(modulated flip angle technique in refocused imagingwithextendedechotrain,MATRIX)技术在诊断下肢深静脉血栓(deepvein thrombosis,DVT)中的临床应用价值。材料与方法前瞻性分析2018年2月至2018年10月来我院血管外科就诊并经多普勒超声检查与D-二聚体检查确诊为下肢深静脉血栓(deep vein thrombosis,DVT)的患者20例,使用联影uMR 770 3.0 T磁共振扫描3D-T1WIMATRIX序列与3D-T1WI-三维磁化准备快速梯度回波(magnetizationpreparedrapid acquisitiongradientecho,MPRAGE)序列,分别计算并比较两种序列的信噪比,血栓-血液对比噪声比;并由2名有经验的影像科诊断医师就2种序列在下腔静脉、髂总静脉、髂外静脉、股静脉上段、股静脉中下段的解剖结构显示情况,伪影情况,以及能否满足诊断需要进行主观评分。所得结果由SPSS 21.0软件通过配对秩和检验进行评价。结果在20例DVT患者中,3D-T1WI-MATRIX序列的SNR为117.20±65.40,血栓-血液CNR为194.28±191.58,显著优于3D-T1WI-MPRAGE序列,SNR为65.23±34.67,血栓-血液CNR为57.24±54.38,两者之间的差异具有统计学意义(P<0.05)。在图像质量主观评分方面,3D-T1WI-MATRIX序列在所有对比片段的评分均高于3D-T1WIMPRAGE序列,其中,在下腔静脉、髂总静脉、髂外静脉、股静脉中下段的评分差异具有统计学意义(P<0.05),在股静脉上段的评分差异没有统计学意义(P>0.05)。结论 3D-T1WI-MATRIX序列作为一种新的磁共振黑血成像序列,相较于3D-T1WIMPRAGE序列,具有更高的SNR和CNR,更少的伪影,为临床DVT的诊断提供了重要的参考依据。
Objective: To investigate the clinical value of 3D-T1WI modulated flip angle technique in refocused imaging with extended echo train(MATRIX) sequences in diagnosis of deep venous thrombosis(DVT). Materials and Methods: In this prospective study, 20 patients clinically were diagnosed with deep venous thrombosis using ultrasound and D-dimer test from February 2018 to October 2018 in our hospital. 3D-T1WI-MATRIX and 3D-T1WI magnetization prepared rapid acquisition gradient echo(MPRAGE) were scanned by United Imaging uMR 770 3.0 T MRI system. The image quality of two sequences were evaluated with signal-to-noise ratio(SNR) and thrombosis vs blood contrast-to-noise ratio(CNR), and observed by two experienced radiologists through the demonstration and artifact of the venous thrombosis and the anatomical structure in five MPR axial pieces in inferior vena cava, common iliac vein,external iliac vein, upper femoral vein and middle-lower femoral vein among two sequences using five-point scale. Using SPSS 21.0 for statistical analysis. Results: In 20 cases of DVT patients, the SNR and CNR in 3D-T1WI-MATRIX were 117.20±65.40, 194.28±191.58, while the SNR and CNR in 3D-T1WI-MPARGE were 65.23±34.67, 57.24±54.38. The differences between them were statistically significant(P<0.05). The subjective image quality score among the two radiologists showed statistically significant differences in inferior vena cava, common iliac vein, external iliac vein, and middle-lower femoral vein in two sequences(P<0.05). there was no significant difference in upper femoral vein(P>0.05). Conclusions: As a black-blood sequence, 3D-T1WI-MATRIX is a new technique which has better SNR and CNR, less artifacts compared to 3D-T1WI-MPARGE which shows great value for DVT diagnosis.
Objective: To investigate the clinical value of 3D-T1WI modulated flip angle technique in refocused imaging with extended echo train(MATRIX) sequences in diagnosis of deep venous thrombosis(DVT). Materials and Methods: In this prospective study, 20 patients clinically were diagnosed with deep venous thrombosis using ultrasound and D-dimer test from February 2018 to October 2018 in our hospital. 3D-T1WI-MATRIX and 3D-T1WI magnetization prepared rapid acquisition gradient echo(MPRAGE) were scanned by United Imaging uMR 770 3.0 T MRI system. The image quality of two sequences were evaluated with signal-to-noise ratio(SNR) and thrombosis vs blood contrast-to-noise ratio(CNR), and observed by two experienced radiologists through the demonstration and artifact of the venous thrombosis and the anatomical structure in five MPR axial pieces in inferior vena cava, common iliac vein,external iliac vein, upper femoral vein and middle-lower femoral vein among two sequences using five-point scale. Using SPSS 21.0 for statistical analysis. Results: In 20 cases of DVT patients, the SNR and CNR in 3D-T1WI-MATRIX were 117.20±65.40, 194.28±191.58, while the SNR and CNR in 3D-T1WI-MPARGE were 65.23±34.67, 57.24±54.38. The differences between them were statistically significant(P<0.05). The subjective image quality score among the two radiologists showed statistically significant differences in inferior vena cava, common iliac vein, external iliac vein, and middle-lower femoral vein in two sequences(P<0.05). there was no significant difference in upper femoral vein(P>0.05). Conclusions: As a black-blood sequence, 3D-T1WI-MATRIX is a new technique which has better SNR and CNR, less artifacts compared to 3D-T1WI-MPARGE which shows great value for DVT diagnosis.
引文
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[12]Treitl KM,Treitl M,Kooijman-Kurfuerst H,et al.Three-dimensional black-blood T1-weighted turbo spin-echo techniques for the diagnosis of deep vein thrombosis in comparison with contrast-enhanced magnetic resonance imaging:a pilot study.Invest Radiol,2015,50(6):401-408.
[13]Yang Q,Duan JG,Fan ZY,et al.Early detection and quantification of cerebral venous thrombosis by magnetic resonance black-blood thrombus imaging.Stroke,2016,47(2):404-409.
[14]Saha P,Andia ME,Modarai B,et al.Magnetic resonance T1 relaxation time of venous thrombus is determined by iron processing and predicts susceptibility to lysis.Circulation,2013,128(7):729-736.
[15]Schmitz SA,O'Regan DP,Gibson D,et al.Magnetic resonance direct thrombus imaging at 3 T field strength in patients with lower limb deep vein thrombosis:a feasibility study.Clin Radiol,2006,61(3):282-286.
[16]Westerbeek RE,Van Rooden CJ,Tan M,et al.Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg.J Thromb Haemost,2008,6(7):1087-1092.
[17]Xie G,Chen H,He X,et al.Black-blood thrombus imaging(BTI):a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis.J Cardiovasc Magn Reson,2017,19(1):4.
[18]Zhang FX.Iliofemoral vein compression syndrome and lower extremity venous reflux disorder.Chin J General Surgery,2011,49(6):483-485.张福先.髂股静脉压迫综合征与下肢静脉回流障碍.中华外科杂志,2011,49(6):483-485.
[2]Vascular surgery group,surgery branch,Chinese medical association.Diagnostic and therapeutic guidelines for deep vein thrombosis(second edition).Chin J General Surgery,2012,50(7):611-614.中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第2版).中华外科杂志,2012,50(7):611-614.
[3]Mewissen MW,Seabrook GR,Meissner MH,et al.Catheter-directed thrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry.Radiology,1999,211(1):39-49.
[4]Wohner N,Sótonyi P,Machovich R,et al.Lytic resistance of fibrin containing red blood cells.Arterioscler Thromb Vasc Biol,2011,31(10):2306-2313.
[5]Group JJW.Guidelines for the diagnosis,treatment and prevention of pulmonary thromboembolism and deep vein thrombosis(JCS 2009).Circ J,2011,75(5):1258-1281.
[6]Dauzat M,Laroche JP,Deklunder G,et al.Diagnosis of acute lower limb deep venous thrombosis with ultrasound:trends and controversies.J Clin Ultrasound,1997,25:343-358.
[7]Dronkers CE,Klok FA,Huisman MV.Current and future perspectives in imaging of venous thromboembolism.J Thromb Haemost,2016,14(9):1696-1710.
[8]Moody AR.Magnetic resonance direct thrombus imaging.J Thromb Haemost,2003,1(7):1403-1409.
[9]Tan M,Mol GC,van Rooden CJ,et al.Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis.Blood,2014,124(4):623-627.
[10]Sadowski EA,Bennett LK,Chan MR,et al.Nephrogenic systemic fibrosis:risk factors and incidence estimation 1.Radiology,2007,243(1):148-157.
[11]Mendichovszky IA,Priest AN,Bowden DJ,et al.Combined MR direct thrombus imaging and non-contrast magnetic resonance venography reveal the evolution of deep vein thrombosis:a feasibility study.Eur Radiol,2017,27(6):2326-2332.
[12]Treitl KM,Treitl M,Kooijman-Kurfuerst H,et al.Three-dimensional black-blood T1-weighted turbo spin-echo techniques for the diagnosis of deep vein thrombosis in comparison with contrast-enhanced magnetic resonance imaging:a pilot study.Invest Radiol,2015,50(6):401-408.
[13]Yang Q,Duan JG,Fan ZY,et al.Early detection and quantification of cerebral venous thrombosis by magnetic resonance black-blood thrombus imaging.Stroke,2016,47(2):404-409.
[14]Saha P,Andia ME,Modarai B,et al.Magnetic resonance T1 relaxation time of venous thrombus is determined by iron processing and predicts susceptibility to lysis.Circulation,2013,128(7):729-736.
[15]Schmitz SA,O'Regan DP,Gibson D,et al.Magnetic resonance direct thrombus imaging at 3 T field strength in patients with lower limb deep vein thrombosis:a feasibility study.Clin Radiol,2006,61(3):282-286.
[16]Westerbeek RE,Van Rooden CJ,Tan M,et al.Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg.J Thromb Haemost,2008,6(7):1087-1092.
[17]Xie G,Chen H,He X,et al.Black-blood thrombus imaging(BTI):a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis.J Cardiovasc Magn Reson,2017,19(1):4.
[18]Zhang FX.Iliofemoral vein compression syndrome and lower extremity venous reflux disorder.Chin J General Surgery,2011,49(6):483-485.张福先.髂股静脉压迫综合征与下肢静脉回流障碍.中华外科杂志,2011,49(6):483-485.