流入反转恢复的稳态收集快速成像技术评估肾动脉狭窄的对照研究  

Estimation of renal artery stenosis with MR IFIR-FIESTA renal artery angiography： a comparison with CT angiography

作　　者：殷小会[1] 韩艳[1] 李锋坦[1] 白人驹[1] 李东[1] 

机构地区：[1]天津医科大学总医院放射科,300052

出　　处：《中华老年医学杂志》2014年第10期1081-1084,共4页Chinese Journal of Geriatrics

基　　金：基金项目：天津市应用基础及前沿技术研究计划（10JCYBJC11000）

摘　　要：目的 与碘对比增强肾动脉CT血管造影（CTA）图像对比,前瞻性评价流入反转恢复的稳态收集快速成像技术（IFIR-FIESTA）评估肾动脉狭窄（RAS）的能力. 方法 对30例老年高血压可疑RAS的患者先后1周内进行了肾动脉3.0T 3D IFIR-FIESTA检查和CTA检查.由两名医师测定IFIR-FIESTA的图像质量及肾动脉Ⅱ、Ⅲ级血管显示率,以CTA为参照标准,2名医师分别以肾动脉支数和患者例数为单位计算IFIR-FIESTA诊断有血液动力学意义的RAS敏感度、特异度、准确度和阴性预测值,并对两名医师通过IFIR-FIESTA判定有无狭窄及狭窄率分级的一致性进行分析. 结果 2名医师对IFIR-FIESTA图像质量的评分分别为（2.16±1.02）分和（2.00±0.14）分,观察者间差异无统计学意义（Z=-0.037,P=0.971）.IFIR-FIESTA与CTA图像显示肾动脉Ⅱ、Ⅲ级血管没有明显差别（x2 =0.298,P=0.585）.以肾动脉支数为单位,医师甲测得的有血液动力学意义的RAS敏感度、特异度、准确度和阴性预测值分别为100％、96％、97％和100％,医师乙的值分别为100％、90％、92％和100％,两位医师诊断有无血液动力学意义RAS病变一致性好,Kappa=0.803;以患者例数为单位,医师甲测得的有血流动力学意义的RAS敏感度、特异度、准确度和阴性预测值分别为100％、95％、97％和100％,医师乙的值分别为100％、85％、90％和100％,2名医师诊断有无血流动力学意义RAS病变一致性较好,Kappa=0.724. 结论 与CTA相比,IFIR-FIESTA不需对比剂即可较好地评估RAS,且无电离辐射,可作为RAS的筛查方法,尤其是在老年人RAS的筛查中应积极推广应用.Objective To prospectively assess the diagnostic accuracy of MR inflow inversion recovery （IFIR） fast imaging employing steady-state acquisition （FIESTA） for detection of renal artery stenosis （RAS）,as compared with renal artery CT angiography （CTA） performed as the reference standard.Methods Thirty patients [18 males,12 females; mean age （65.0±12.1） years] with arterial hypertension and suspected RAS were examined by 3.0-T 3D MR IFIR-FIESTA and renal artery CTA within a week.The IFIR-FIESTA image quality,the IFIR-FIESTA and CTA in display of second-order and third-order branches of renal artery were assessed by two experienced readers.The sensitivity,specificity,accuracy,and negative predictive value （NPV） of IFIR-FIESTA were calculated on artery-by-artery and patient-by-patient bases by the two readers.The inter-observer agreement between the two readers in determining the presence and grade of renal artery stenosis was assessed.Results The scores of qualification of IFIR-FIESTA image quality by reader A and B were （2.16±1.02） and （2.00 ± 0.14）,there was no significant difference between them （Z=-0.037,P=0.971）.IFIR-FIESTA and CTA in display of second-order and third-order branches of renal artery had no significant difference （x2 =0.298,P=0.585）.In the assessment of all 64 main renal arteries by reader A,IFIR FIESTA on artery-by-artery basis had sensitivity,specificity,accuracy,and NPV of 100%,96%,97%,and 100%,respectively; the above parameters assessed by reader B were 100%,90%,93%,and 100%,respectively.There was excellent inter-observer agreement （Kappa=0.803） with the presence or absence of hemodynamically significant RAS.In the assessment of all 30 patients by reader A,IFIR-FIESTA on patient-by-patient basis had sensitivity,specificity,accuracy,and NPV of 100%,95%,97%,and 100%; the above parameters assessed by reader B were 100%,85%,90%,and 100%,respectively; there was good inter observer agreement （Kappa=0.724） with the presence or absence of hemodynamica

关 键 词：肾动脉梗阻 成像 三维 血管造影术 

分 类 号：R692[医药卫生—泌尿科学] R816.7[医药卫生—外科学]