三维动态增强磁共振血管成像在老年人糖尿病下肢动脉疾病诊断中的应用  

Application of three dimensional dynamic contrast-enhanced magnetic resonance angiography in elderly patients with diabetic peripheral arterial stenosal and occlusive diseases

作　　者：朱向玉[1] 武乐斌[1] 史浩[1] 邱秀玲[1] 杨贞振[1] 

机构地区：[1]山东省医学影像学研究所MR室,济南市250021

出　　处：《中华老年医学杂志》2008年第2期87-90,共4页Chinese Journal of Geriatrics

基　　金：山东省自然科学基金（Y2006C97）

摘　　要：目的探讨三维动态增强磁共振血管成像（3DDCE-MRA）在诊断老年糖尿病患者下肢动脉疾病中的临床价值。方法对35例临床确诊为糖尿病下肢动脉闭塞性疾病的老年患者行3DDCE-MRA检查，计算机后处理得到下肢动脉血管树，并与其下肢动脉数字减影血管造影（DSA）结果进行对照，分析3DDCE—MRA临床应用价值。结果35例患者均获得清晰的下肢血管树图像。3DDCE-MRA对血管O～4级狭窄检出敏感度、特异度、阳性预测值和阴性预测值分别为：0级：76％、83％、77％和82％；1级：80％、82％、87％和95％；2级：84％、90％、96％和71％；3级：89％、91％、93％和98％；4级：92％、96％、97％和94％。两种检查方法对于下肢动脉5级狭窄检出结果差异无统计学意义。血管狭窄级别和3DDCE—MRA检出敏感度、特异度显著相关。结论3DDCE—MRA评价在下肢动脉病变中血管分级、狭窄部位、程度等方面，与动脉DSA检查效果相同，为一种诊断老年人糖尿病下肢动脉闭塞性疾病简便、可靠、无创的检查方法。Objective To evaluate the clinical application of three dimensional （3D） dynamic contrast-enhanced magnetic resonance angiography （DCE-MRA） for diagnosis and assessment of diabetic peripheral arterial stenosal and occlusive diseases in elderly patients. Methods Thirty-five elderly patients with suspected stenosed and occlusive diseases of peripheral arteries underwent 3D DCE-MRA. Further post-processing was performed with the pre and post enhancement imaging of the same anatomic position. Digital subtraction angiography was performed as the standard reference in 35 patients. Results Distinct imagings of 3D DCE-MRA of the 35 patients were obtained on a workstation. Sensitivity, specificity, negative and positive predictive values were calculated for all segments together and separately. For normal peripheral vessels（grade 0）, sensitivity, specificity, negative and positive predictive values were 76%, 83%, 77%, 82% respectively; for vessel stenosis with less than 20% of a lumen reduction（grade 1） ： 80%, 82%, 87%, 95% ; for vessel stenosis with less than 20%-49% of a lumen reduction（grade 2）： 84%, 90%, 96%, 71% for vessel stenosis with less than 50%- 99% of a lumen reduction（grade 3） ： 89%, 91%, 93%, 98% and for vessel occlusion： 92%, 96%, 97%, 940//00. The results of both CE-MRA and DSA in detection of peripheral arterial stenosis with 5 grading system showed no difference after kappa statistical analysis. Pearson correlation analysis showed that peripheral arterial stenosis grading was significantly correlated with sensitivity and specificity of 3D DCE-MRA. Conclusions In comparison to intra-arterial DSA, 3D DCE-MRA has the same effect in demonstrating and detecting the position and degree of diabetic peripheral arterial stenosis. As a noninvasive, non-radiation, less-complication, simple and credible technique, 3D DCE-MRA will be well accepted and applied.

关 键 词：糖尿病 2型 磁共振血管造影术 外周血管疾病 

分 类 号：R445.2[医药卫生—影像医学与核医学]