【作者】 刘颖；

【导师】 翟冬枝；

【作者基本信息】 郑州大学 ， 医学影像学和核医学， 2017， 硕士

【摘要】 目的探讨3.0T非增强磁共振血管成像对下肢动脉血管疾病诊断的可行性及临床价值。资料与方法收集2016年3月至2016年7月河南中医药大学第一附属医院,已有下肢动脉病变临床症状的15名患者所有的影像学资料。所有患者均先行非增强磁共振血管(NCE-MRA)检查后再行增强磁共振血管(CE-MRA)检查。查出病变的这15名患者,为求更准确的诊断及进一步治疗,在一个月内行CTA或DSA检查。行磁共振检查时,扫描范围为腹主动脉下段到踝关节水平。将下肢动脉系统分为17段(腹主动脉下段,左右髂总、髂外动脉,左右股总、股浅动脉,左右腘动脉,左右胫前、胫后动脉,左右腓动脉)。一名医师测量15名患者共255段下肢血管的信噪比(SNR)和对比噪声比(CNR);另由两名影像科主治医师对图像的成像质量进行评分,并且对血管狭窄程度进行评估。用SPSS20.0统计软件对数据进行统计分析,各段动脉的SNR和CNR结果用(?)表示。对NCE-MRA及CE-MRA的图像质量评分采用Wilcoxon配对符号秩和检验。以CE-MRA为标准,计算NCE-MRA诊断下肢动脉显著性狭窄(2级和3级)的敏感度、特异度、阳性预测值、阴性预测值、准确度。用Kappa检验,检验NCE-MRA诊断下肢动脉显著性狭窄与CE-MRA检查结果的一致性。为进一步探讨NCE-MRA的诊断效能,以DSA或CTA诊断结果做为金标准,计算NCE-MRA诊断下肢动脉显著性狭窄(2级和3级)的敏感度、特异度、阳性预测值、阴性预测值、准确度。用Kappa检验,检验NCE-MRA诊断下肢动脉显著性狭窄与DSA/CTA检查结果的一致性。结果15例病例中4名患者单侧肢端溃疡或坏疽,5例单侧或双侧下肢静息痛,6例间歇性跛行。5名行DSA检查,10名患者行CTA检查。15名患者行非增强磁共振检查均扫描成功。15名患者255段血管中,双下肢动脉血管的平均SNR和CNR分别为140.24±28.80和118.88±27.55。对于静脉污染这方面的评分来说,小腿部的动脉血管NCE-MRA和CE-MRA评为1级和2级的分别为30个和19个,静脉污染情况少于CE-MRA,差异有统计学意义(Z=4.583,P<0.01);盆腹部NCE-MRA和CE-MRA评为1级和2级分别为12个和15个,静脉污染情况多于CE-MRA,差异有统计学意义(Z=2.070,P<0.05)。以CE-MRA结果为标准,NCE-MRA诊断下肢动脉显著性狭窄的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为92.19%、97.91%、93.65%、97.40%、96.47%。Kappa检验结果显示,NCE-MRA和CE-MRA诊断下肢动脉显著性狭窄的一致性较好(Kappa=0.906,P<0.05)。以DSA/CTA结果为金标准,NCE-MRA诊断下肢动脉显著性狭窄的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为96.72%、97.94%、93.65%、98.96%、97.65%。Kappa检验结果显示,NCE-MRA和DSA诊断下肢动脉显著性狭窄的一致性较好(Kappa=0.936,P<0.05)。结论采用3.0T磁共振非增强血管成像技术能获得图像质量较高的下肢动脉血管成像,可清晰显示下肢动脉系统及狭窄部位和程度。患有下肢动脉血管疾病的患者行非增强磁共振血管成像扫描的成功率较高。NCE-MRA在检出下肢动脉血管显著性狭窄的敏感度和特异度较高,有一定的诊断价值。可以为临床提供一种可靠的替代检查方法。更多还原

【Abstract】 PurposeTo explore the feasibility and clinical value of 3.0T magnetic resonance imaging Triggered Angiography None Contrast Enhanced(TRANCE)technique in the diagnosis of lower extremity arterial disease.Materials and methodsCollected from March 2016 to July 2016,Henan University of Traditional Chinese Medicine,the first Affiliated Hospital,the clinical symptoms of lower extremity arterial disease in 15 patients with all the imaging data.All patients underwent NCE-MRA examination and then enhanced magnetic resonance CE-MRA examination.The lesions were detected in 15 patients,and for further accurate diagnosis and treatment,in a month with CTA or DSA examination.The range of magnetic resonance imaging is the lower part of the abdominal aorta to the ankle joint level.The lower extremity arterial system is divided into 17 segments(lower abdominal aorta,left and right iliac,external iliac artery,left and right shares,superficial femoral artery,left and right popliteal artery,left and right tibial artery,posterior tibial artery,left and right peroneal artery).A physician measured the signal to noise ratio(SNR)and contrast to noise ratio(CNR)of the 255 segments of the lower extremities in 15 patients;the quality of NCE-MRA and CE-MRA images were evaluated by two imaging physicians,and the degree of stenosis was evaluated.The data were analyzed by statistical software SPSS20.0,the SNR and CNR of NCE-MRA angiography,were expressed by?x±s.The Wilcoxon paired signed rank sum test was used to evaluate the image quality of NCE-MRA and CE-MRA.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of NCE-MRA in the diagnosis of lower extremity arterial stenosis(grade 2 and grade 3)were calculated by using CE-MRA as standard.Kappa test was used to test the consistency of NCE-MRA and CE-MRA in the diagnosis of arterial stenosis of lower extremity.To further explore the diagnostic efficacy of NCE-MRA,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of NCE-MRA in the diagnosis of lower extremity arterial stenosis(grade 2 and grade 3)were calculated by using DSA/CTA as the gold standard.Kappa test was used to test the consistency of NCE-MRA and DSA/CTA in the diagnosis of arterial stenosis of lower extremity.ResultsOf the 15 patients,four patients had unilateral acral ulcers or gangrene,five had unilateral or bilateral lower extremity resting pain,and six had intermittent claudication.Five patients were examined by DSA and 10 patients underwent CTA.In 15 patients,the mean SNR and CNR of the 255 arterial blood vessels of the lower extremities were 140.24±28.80 and 118.88±27.55 respectively.For the intravenous contamination of this score,the calf of the arterial NCE-MRA and CE-MRA as 1 and 2 were 30 and 19,and the intravenous contamination was less than CE-MRA,the difference was statistically(Z=4.583,P <0.01).The abdominal arterial NCE-MRA and CE-MRA as 1 and 2 were 12 and 15,respectively,and the intravenous contamination was more than CE-MRA,the difference was statistically significant(Z=2.070,P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 92.19%,97.91%,93.65%,97.40% and 96.47% respectively in the diagnosis of superior stenosis of lower extremity with CE-MRA as the standard.The Kappa test showed that NCE-MRA and CE-MRA had better agreement in the diagnosis of lower extremity arterial stenosis(Kappa = 0.906,P <0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of NCE-MRA were 96.72%,97.94%,93.65%,98.96% and 97.65% respectively in the diagnosis of lower extremity arterial stenosis with DSA/CTA as the gold standard.The results of Kappa test showed that NCE-MRA and DSA/CTA had better agreement in the diagnosis of lower extremity arterial stenosis(Kappa = 0.936,P <0.05).ConclusionUsing 3.0T magnetic resonance TRANCE technique can be used to obtain high image quality lower extremity arterial imaging,can clearly show the lower extremity arterial system and stenosis and extent.Non-enhanced magnetic resonance angiography in the diagnosis of lower extremity arterial disease has a higher success rate.NCE-MRA in the detection of lower extremity arterial stenosis of the sensitivity and specificity is higher,and have some diagnostic value.NCE-MRA can provide a reliable alternative to clinical examination methods.更多还原