对比增强MR血管成像诊断糖尿病下肢动脉闭塞症膝以下动脉狭窄的价值  

Evaluation of infrapopliteal occlusive disease with contrast-enhanced MR angiography in diabetic patients

作　　者：张磊 畅坚 吴云[2] 师冬春 赵小英[3] 

机构地区：[1]解放军第三0六医院医学影像科,北京100101 [2]中国科学院强磁场科学中心 [3]安徽医科大学第一附属医院放射科

出　　处：《中华放射学杂志》2014年第8期664-669,共6页Chinese Journal of Radiology

摘　　要：目的 探讨对比增强MR血管成像（CE MRA）诊断糖尿病下肢动脉闭塞症膝以下动脉狭窄的价值.方法 回顾性分析均行下肢动脉CE MRA和DSA检查,髂动脉、股动脉、胭动脉均无明显狭窄或狭窄程度＜75％的105例2型糖尿病合并下肢动脉闭塞症患者.将患侧小腿及足踝部动脉按照解剖部位行9段法划分血管节段,分别为胫腓动脉干、胫前动脉上段、胫前动脉下段、胫后动脉上段、胫后动脉下段、腓动脉上段、腓动脉下段、足背动脉和足底动脉,共945个节段.分别采用CE MRA及DSA评估血管狭窄程度,并将各动脉节段按照狭窄程度分为＜30％、≥30％且＜50％、≥50％且＜75％、≥75％且＜100％及100％组,以DSA结果作为金标准,采用一致性检验（Kappa值）分析CE MRA与DSA诊断结果的一致性.绘制ROC曲线,判断CE MRA诊断下肢动脉病变的准确度.结果 105例患者单侧踝以上动脉的945个节段中,923个（97.7％,923/945）节段可用于观察统计.DSA、CE MRA均显示390个节段血管闭塞（42.3％,390/923）.2种方法诊断各动脉节段狭窄的一致性由高到低依次为：腓动脉上段、胫后动脉上段、胫后动脉下段、胫前动脉上段、胫前动脉下段、胫腓动脉干、足背动脉、足底动脉和腓动脉下段,Kappa值依次为0.88、0.86、0.84、0.84、0.81、0.77、0.75、0.75和0.73,P均＜0.05.CE MRA诊断923个动脉节段狭窄的AUC为0.893,95％可信区间为0.882 ～ 0.904.结论 MRA对于糖尿病患者膝以下动脉狭窄病变具有较高的诊断准确度,具有临床应用价值.Objective To evaluate the diagnostic accuracy of contrast-enhanced MR angiography （CE MRA） in infrapopliteal occlusive diseases of diabetic patients.Methods A total of 105 patients with known diabetes and peripheral vascular occlusive disease who underwent both CE MRA and DSA examnations were included in this study.They had no obvious stenosis or with stenosis of less than 75％ in iliac,femoral,and popliteal arteries.Every infra-popliteal artery was anatomically divided into 9 vascular segments as tibiofibular trunk artery,proximal and distal anterior tibial artery,proximal and distal posterior tibial artery,proximal and distal peroneal artery,plantar and dorsalis pedis artery.There were 945 segments.The arterial stenosis was accessed with CE MRA and DSA respectively.The segments were scored in 5 categories as＜30％,≥30％ and＜50％,≥50％ and＜75％,≥75％ and＜100％,and 100％ according to stenostic degrees.The Kappa test was used to compare the diagnostic consistency of CE MRA and DSA.Taken DSA as a gold standard for reference,ROC curve was drawn to calculate the diagnostic accuracy of CE MRA in diagnosis of lower limb arterial disease.Results The ratio of statistically valid segments for both CE MRA and DSA were 97.7％ （923/945） in 945 vessel segments of 105 patients,and 390 of 923 arterial segments were both indicated as occlusion by CE MRA and DSA.The diagnostic consistency for the segments was listed in the decreasing order as follows：proximal peroneal artery,proximal posterior tibial artery,distal posterior tibial artery,proximal anterior tibial artery,distal anterior tibial artery,tibiofibular trunk artery,dorsalis pedis artery,plantar artery,distal peroneal artery,and corresponding Kappa values were 0.88,0.86,0.84,0.84,0.81,0.77,0.75,0.75 and 0.73,P＜ 0.05.The AUC（area under ROC curve） of CE MRA was 0.893 with 95％ confidence interval of 0.882 to 0.904.Conclusion CE MRA is an accurate imaging modality in the diagnosis of infrapopliteal occlusive disease s for diabetes.

关 键 词：糖尿病 动脉闭塞性疾病 磁共振血管造影术 血管造影术 数字减影 

分 类 号：R445.2[医药卫生—影像医学与核医学] R587.2[医药卫生—诊断学]