非对比剂增强MRA在肾静脉血管成像中的应用价值
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摘要
目的:评估多反转脉冲空间标记(SLEEK)非对比剂增强磁共振血管成像(NCE-MRA)技术对显示肾脏肿瘤患者肾静脉的可行性及静脉内瘤栓的诊断效能。方法:纳入行手术治疗的肾脏肿瘤患者共32例,所有患者均知情同意,32例患者均行SLEEK序列扫描,获取双肾静脉及下腔静脉原始图像。对70支肾静脉及32支下腔静脉的原始图像、最大密度投影(MIP)图像、多平面重建图像进行评估,包括图像质量、瘤栓显示,以病理结果为金标准,评估SLEEK对瘤栓显示的准确度、敏感度及特异度。结果:非肿瘤侧肾静脉(34支)图像质量评分均在2分及以上,肿瘤侧97.2%(35/36)的肾静脉图像质量评分在2分及以上。1支肿瘤侧肾静脉显示差,不足以用于诊断,对余下肿瘤侧肾静脉及下腔静脉以病理为金标准进行评估,SLEEK显示16支肾静脉有瘤栓,14支下腔静脉有瘤栓,病理均证实;SLEEK显示无瘤栓的静脉病理中亦未发现瘤栓。SLLEK诊断准确度、敏感度及特异度均为100%。两位医师评分及诊断的一致性较好,Kappa值均>0.75。结论:SLEEK可准确诊断肾脏肿瘤患者静脉内瘤栓存在情况,并可多角度观察瘤栓范围,从而指导临床手术方案的选择。
Objective:To evaluate the diagnostic value of non contrast enhanced MRA(NCE MRA)using spatial labeling with multiple inversion pulses(SLEEK)in assessing intravenous tumor embolus in patients with renal tumor.Methods:Informed consents were obtained from 32 patients who underwent renal tumor surgery.All patients received SLEEK MR examination,anatomic images of bilateral renal veins and inferior vena cava were obtained.Original image of 70 renal veins and 32 inferior vena cava were assessed,The image quality,display of intravenous tumor embolus were evaluated by MIP and MPR techniques.Taking pathology as gold standard,the diagnostic accuracy,sensitivity and specificity of SLEEK in displaying intravenous tumor embolus were evaluated.Results:Of 34 renal veins on intact side,the image quality score was 2points and above.Of the renal vein on tumor side,97.2%(35/36)were scored as 2points and above.The image of one renal vein on tumor side was not clear enough for diagnosis.Among the remaining renal veins of tumor side and inferior vena cava,SLEEK detected 16 renal venous tumor embolus and 14 inferior vena cava tumor embolus,which were all confirmed by pathology.The diagnostic accuracy,sensitivity and specificity of SLEEK in detecting tumor embolus were100%for all.The scores evaluated by two radiologists showed good consistency with Kappa values >0.75.Conclusion:SLEEK is accurate in the diagnosis of intravenous tumor embolus and can display tumor embolus in multiple views,which is be helpful for the selection of surgical treatment planning.
Objective:To evaluate the diagnostic value of non contrast enhanced MRA(NCE MRA)using spatial labeling with multiple inversion pulses(SLEEK)in assessing intravenous tumor embolus in patients with renal tumor.Methods:Informed consents were obtained from 32 patients who underwent renal tumor surgery.All patients received SLEEK MR examination,anatomic images of bilateral renal veins and inferior vena cava were obtained.Original image of 70 renal veins and 32 inferior vena cava were assessed,The image quality,display of intravenous tumor embolus were evaluated by MIP and MPR techniques.Taking pathology as gold standard,the diagnostic accuracy,sensitivity and specificity of SLEEK in displaying intravenous tumor embolus were evaluated.Results:Of 34 renal veins on intact side,the image quality score was 2points and above.Of the renal vein on tumor side,97.2%(35/36)were scored as 2points and above.The image of one renal vein on tumor side was not clear enough for diagnosis.Among the remaining renal veins of tumor side and inferior vena cava,SLEEK detected 16 renal venous tumor embolus and 14 inferior vena cava tumor embolus,which were all confirmed by pathology.The diagnostic accuracy,sensitivity and specificity of SLEEK in detecting tumor embolus were100%for all.The scores evaluated by two radiologists showed good consistency with Kappa values >0.75.Conclusion:SLEEK is accurate in the diagnosis of intravenous tumor embolus and can display tumor embolus in multiple views,which is be helpful for the selection of surgical treatment planning.
引文
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[12]Xu J,Shi D,Li Y,et al.Non-enhanced MR angiography of renal artery using inflow-sensitive inversion recovery pulse sequence:a prospective comparison with enhanced CT angiography[J].Eur J Radiol,2011,80(2):e57-e63.
[2]Abel EJ,Thompson RH,Margulis V,et al.Perioperative outcomes following surgical resection of renal cell carcinoma with inferior vena cava thrombus extending above the hepatic veins:a contemporary multicenter experience[J].Eur Urol,2014,66(3):584-592.
[3]Tsili AC.Advances of multidetector computed tomography in the characterization and staging of renal cell carcinoma[J].World J Radiol,2015,7(6):110-127.
[4]郭媛.彩色多普勒超声应用于肾癌合并静脉瘤栓诊断中的临床价值[J].临床合理用药杂志,2015,8(3):76-77.
[5]Shonai T,Takahashi T,Ikeguchi H,et al.Improved arterial visibility using short-tau inversion-recovery(STIR)fat suppression in non-contrast-enhanced time-spatial labeling inversion pulse(Time-SLIP)renal MR angiography(MRA)[J].J Magn Reson Imaging,2009,29(6):1471-1477.
[6]Shimada K,Isoda H,Okada T,et al.Unenhanced MR portography with a half-fourier fast spin-echo sequence and time-space labeling inversion pulses:preliminary results[J].AJR,2009,193(1):106-112.
[7]孟晓岩,汤浩,王秋霞,等.非对比剂增强MR血管成像联合多反转空间标记脉冲技术在肺动脉成像的可行性研究[J].磁共振成像,2014,5(5):343-347.
[8]Zhang Y,Xing Z,Liu Y,et al.Nonenhanced renal MR angiography using steady-state free precession(SSFP)and time-spatial labeling inversion pulse(Time-SLIP):repeatability and comparison of different tagging location[J].Abdom Imaging,2014,39(5):1000-1008.
[9]Tang H,Wang Z,Wang L,et al.Depiction of transplant renal vascular anatomy and complications:unenhanced MR angiography by using spatial labeling with multiple inversion pulses[J].Radiology,2014,271(3):879-887.
[10]Wu M,Xu J,Shi D,et al.Evaluations of non-contrast enhanced MR venography with inflow inversion recovery sequence in diagnosing budd-chiari syndrome[J].Clin Imaging,2014,38(5):627-632.
[11]Bultman EM,Klaers J,Johnson KM,et al.Non-contrast enhanced 3DSSFP MRA of the renal allograft vasculature:a comparison between radial linear combination and cartesian inflowweighted acquisitions[J].Magn Reson Imaging,2014,32(2):190-195.
[12]Xu J,Shi D,Li Y,et al.Non-enhanced MR angiography of renal artery using inflow-sensitive inversion recovery pulse sequence:a prospective comparison with enhanced CT angiography[J].Eur J Radiol,2011,80(2):e57-e63.