心电触发非对比增强血管造影技术在3.0TMRA诊断下肢动脉病变中的应用——与DSA对照
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摘要
目的 探讨心电触发非对比增强血管造影(TRANCE)技术在3.0T非对比增强(NCE)-MRA诊断下肢动脉病变中应用的可行性及临床价值。方法 38例有临床症状的下肢动脉狭窄病变患者DSA检查前接受NCE-MRA检查。2名MRI医师根据4分法,分别对NCE-MRA图像质量进行评分,根据4级分级标准评价下肢动脉狭窄程度。以DSA为金标准,分析计算NCE-MRA诊断下肢动脉显著狭窄(狭窄程度≥2级)的灵敏度、特异度、准确度、阳性预测值、阴性预测值。采用Kappa检验分析2名MRI医师对图像质量评分一致性及NCE-MRA与DSA诊断下肢动脉各节段显著狭窄一致性。结果 2名MRI医师对主髂动脉段、股腘动脉段、膝下动脉段NCE-MRA图像质量评分的一致性K值,分别为0.93、0.89、0.82(P均<0.05)。NCE-MRA诊断下肢动脉狭窄病变符合DSA金标准比例为95.15%(255/268),高估率、低估率分别为3.73%、1.12%。NCE-MRA诊断下肢动脉显著狭窄的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为91.7%、90.3%、91.6%、85.5%、93.7%,其中主髂动脉段分别为95.8%、94.2%、96.8%、93.2%、98.4%,股腘动脉段分别为93.2%、93.7%、94.7%、91.8%、96.3%,膝下动脉段分别为92.4%、85.6%、88.3%、78.6%、86.6%。NCE-MRA与DSA诊断下肢动脉显著狭窄一致性K值为0.85,其中主髂动脉段、股腘动脉段、膝下动脉段分别为0.90、0.87、0.73。结论 NCE-MRA能够清晰显示下肢动脉狭窄病变,具有较高的图像质量和诊断准确度,可作为一种可靠的替代检查方法。
Objective To discuss the feasibility and the clinical value of ECG-triggered non-contrastenhanced MR angiography(TRANCE) technique in diagnosing lower extremity arterial diseases with 3.0 T MR unit. Methods A total of 38 patients with symptomatic lower extremity arterial stenotic diseases received non-contrast enhanced MRA(NCE-MRA) examination before digital subtraction angiography(DSA) was carried out. According to the 4-point scale method, the quality of NCE-MRA images was evaluated by two MRI physicians. Taking DSA results as the gold standard, the sensitivity, specificity, the diagnostic accuracy, the positive and negative predictive values in diagnosing significant stenosis of lower extremity arteries(stenosis degree ≥2 grade) determined on NCE-MRA were calculated. By using Kappa test analysis,the consistency of image quality score between two MRI physicians and the consistency in diagnosing significant narrowing of each lower extremity arterial segment between NCE-MRA and DSA were evaluated.Results Kappa values of the image quality consistency scores between two MRI physicians for the stenotic diagnosis of main iliac artery, femoropopliteal artery and inferior genicular artery were 0.93, 0.89 and 0.82 respectively(P<0.05 in all). The proportion of the diagnosis of lower extremity arterial stenosis made by NCEMRA that accorded with DSA gold standard was 95.15%(255/268), the overvalued ratio and the undervalued ratio were 3.73% and 1.12% respectively. For the diagnosis of significant stenosis of lower extremity arteries,the sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of NCE-MRA were91.7%, 90.3%, 91.6%, 85.5% and 93.7% respectively, which were 95.8%, 94.2%, 96.8%, 93.2% and 98.4%respectively for the main iliac artery segment, 93.2%, 93.7%, 94.7%, 91.8% and 96.3% respectively for femoropopliteal artery segment, and 92.4%, 85.6%, 88.3%, 78.6% and 86.6% respectively for inferior genicular artery segment. The Kappa value of the consistency of NCE-MRA and DSA in the diagnosis of significant stenosis of the lower extremity arteries was 0.85, which for the main iliac artery segment, for the femoropopliteal artery segment and for the inferior genicular artery segment were 0.90, 0.87 and 0.73 respectively. Conclusion NCE-MRA can clearly display lower extremity arterial stenosis with higher image quality and diagnostic accuracy, which can be used as a reliable alternative examination method.
Objective To discuss the feasibility and the clinical value of ECG-triggered non-contrastenhanced MR angiography(TRANCE) technique in diagnosing lower extremity arterial diseases with 3.0 T MR unit. Methods A total of 38 patients with symptomatic lower extremity arterial stenotic diseases received non-contrast enhanced MRA(NCE-MRA) examination before digital subtraction angiography(DSA) was carried out. According to the 4-point scale method, the quality of NCE-MRA images was evaluated by two MRI physicians. Taking DSA results as the gold standard, the sensitivity, specificity, the diagnostic accuracy, the positive and negative predictive values in diagnosing significant stenosis of lower extremity arteries(stenosis degree ≥2 grade) determined on NCE-MRA were calculated. By using Kappa test analysis,the consistency of image quality score between two MRI physicians and the consistency in diagnosing significant narrowing of each lower extremity arterial segment between NCE-MRA and DSA were evaluated.Results Kappa values of the image quality consistency scores between two MRI physicians for the stenotic diagnosis of main iliac artery, femoropopliteal artery and inferior genicular artery were 0.93, 0.89 and 0.82 respectively(P<0.05 in all). The proportion of the diagnosis of lower extremity arterial stenosis made by NCEMRA that accorded with DSA gold standard was 95.15%(255/268), the overvalued ratio and the undervalued ratio were 3.73% and 1.12% respectively. For the diagnosis of significant stenosis of lower extremity arteries,the sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of NCE-MRA were91.7%, 90.3%, 91.6%, 85.5% and 93.7% respectively, which were 95.8%, 94.2%, 96.8%, 93.2% and 98.4%respectively for the main iliac artery segment, 93.2%, 93.7%, 94.7%, 91.8% and 96.3% respectively for femoropopliteal artery segment, and 92.4%, 85.6%, 88.3%, 78.6% and 86.6% respectively for inferior genicular artery segment. The Kappa value of the consistency of NCE-MRA and DSA in the diagnosis of significant stenosis of the lower extremity arteries was 0.85, which for the main iliac artery segment, for the femoropopliteal artery segment and for the inferior genicular artery segment were 0.90, 0.87 and 0.73 respectively. Conclusion NCE-MRA can clearly display lower extremity arterial stenosis with higher image quality and diagnostic accuracy, which can be used as a reliable alternative examination method.
引文
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[2]Prince MR,Zhang HL,Roditi GH,et al.Risk factors for NSF:a literature review[J].J Magn Reson Imaging,2009,30:1298-1308.
[3]Wu G,Yang J,Zhang T,et al.The diagnostic value of noncontrast enhanced quiescent interval single shot(QISS)magnetic resonance angiography at 3T for lower extremity peripheral arterial disease,in comparison to CT angiography[J].J Cardiovasc Magn Reson,2016,18:71.
[4]谢珊珊,程敬亮,张勇,等.三种方法诊断大脑中动脉狭窄的对照研究[J].介入放射学杂志,2014,23:96-100.
[5]Rydahl C,Thomsen HS,Marckmann P.High prevalence of nephrogenic systemic fibrosis in chronic renal failure patients exposed to gadodiamide:a gadolinium-containing magnetic resonance contrast agent[J].Invest Radiol,2008,43:141-144.
[6]Pollak AW,Kramer CM.MRI in lower extremity peripheral arterial disease:recent advancements[J].Curr Cardiovasc Imaging Rep,2013,6:55-60.
[7]Hahn WY,Hecht EM,Friedman B,et al.Distal lower extremity imaging:prospective comparison of 2-dimensional time of flight,3-dimensional time-resolved contrast-enhanced magnetic resonance angiography,and 3-dimensional bolus chase contrast-enhanced magnetic resonance angiography[J].J Comput Assist Tomogr,2007,31:29-36.
[8]Miyazaki M,Isoda H.Non-contrast-enhanced MR angiography of the abdomen[J].Eur J Radiol,2011,80:9-23.
[9]Gutzeit A,Sutter R,Froehlich JM,et al.ECG-triggered noncontrast-enhanced MR angiography(TRANCE)versus digital subtraction angiography(DSA)in patients with peripheral arterial occlusive disease of the lower extremities[J].Eur Radiol,2011,21:1979-1987.
[10]Offerman EJ,Hodnett PA,Edelman RR,et al.Non-enhanced methods for low-extremity MRA:a Phantom study examining the effects of stenosis and pathologic flow waveforms at 1.5T[J].J Magn Reson Imaging,2011,33:401-408.
[11]Hodnett PA,Koktzoglou I,Davarpanah AH,et al.Evaluation of peripheral arterial disease with nonenhanced quiescent-interval single-shot MR angiography.Radiology,2011,260:282-293.
[12]Wheaton AJ,Miyazaki M.Non-contrast enhanced MR angiography:physical principles[J].J Magn Reson Imaging,2012,36:286-304.
[13]Lim RP,Hecht EM,Xu J,et al.3D nongadolinium-enhanced ECG-gated MRA of the distal lower extremities:preliminary clinical experience[J].J Magn Reson Imaging,2008,28:181-189.
[14]Liu X,Zhang N,Fan Z,et al.Detection of infragenual arterial disease using non-contrast-enhanced MR angiography in patients with diabetes[J].J Magn Reson Imaging,2014,40:1422-1429
[15]Thierfelder KM,Meimarakis G,Nikolaou K,et al.Non-contrastenhanced MR angiography at 3 Tesla in patients with advanced peripheral arterial occlusive disease[J].PLo S One,2014,9:e91078.
[16]Liu J,Zhang N,Fan Z,et al.Image Quality and Stenosis Assessment of Non-Contrast-Enhanced 3-T Magnetic Resonance Angiography in Patients with Peripheral Artery Disease Compared with Contrast-Enhanced Magnetic Resonance Angiography and Digital Subtraction Angiography[J].PLOS one,2016,11:e0166467.