序列优化的下肢MR血管成像诊断糖尿病足的价值  

Analysis on optimal protocol of lower extremity MR angiography in patients with diabetic foot

作　　者：唐鹤菡[1] 李昌宪[1] 袁元[1] 冉兴无[2] 

机构地区：[1]四川大学华西医院放射科,成都610041 [2]四川大学华西医院糖尿病足诊治中心,成都610041

出　　处：《中华放射学杂志》2015年第1期6-10,共5页Chinese Journal of Radiology

基　　金：国家自然科学基金面上项目（81170776）;四川省学术和技术带头人培养基金（JH2014009）;四川省科技支撑计划项目（2011SZ0220）

摘　　要：目的探讨序列优化的下肢MRA诊断糖尿病足的价值。方法前瞻性纳入临床及常规下肢影像检查未见异常，经超声检查排除下肢动脉病变的28名志愿者，分2次行下肢小腿血管MRI增强扫描，并行采集加速因子（PIF）分别为3、4。测量计算胭动脉、胫后动脉、胫前动脉及腓总动脉的信噪比（SNR）及对比噪声比（CNR），并进行图像质量评分。收集临床确诊的糖尿病足患者20例，同一患者均采用方案1（传统的Care—bolus扫描）和方案2（行优化K空间中心填充的延迟时间扫描）行大腿、小腿及足部的增强MRA扫描。对采用不同扫描方案图像的股动脉、胭动脉、胫后动脉、胫前动脉、腓总动脉、足背动脉、足底内侧动脉及足底外侧动脉进行评分，并对大腿、小腿及足部血管进行静脉重叠评分。采用配对t检验比较志愿者在不同PIF时各部位SNR及CNR的差异；采用Wilcoxon检验比较志愿者在不同PIF时小腿血管显示的差异以及患者采用2种方案扫描对各部位血管的评分和静脉重叠评分的差异。结果志愿者行小腿MRA，PIF=3时，胴动脉、胫后动脉、腓总动脉的SNR分别为267±84、174±51、147±42，CNR分别为232±83、139±51、108±39；PIF=4时，上述部位的SNR分别为239±73、157±53、132±35，CNR分别为206±71、124±50、103±33，上述部位PIF=3时的SNR及CNR均高于PIF=4时，差异有统计学意义（t值为2．31～4．11，P均〈0．05）。PIF为3或4时，上述血管显示评分的差异均无统计学意义（P均〉0．05）。20例糖尿病足患者采用方案1行下肢MRA，胭动脉、胫后动脉、胫前动脉、腓总动脉、足背动脉、足底内侧动脉、足底外侧动脉的图像质量评分分别为（3．40±0．82）、（2．70±0．80）、（2．50±1．00）、（2．20±0．77）、（2．30±0．92）、（2．15±1．04）、（1．45±0．60）分，小腿及足部的静脉重叠评分分别为（2．20Objective To explore the optimal protocol of lower-extremity contrast-enhanced MRA （CE-MRA） in the evaluation of diabetic foot. Methods Twenty eight healthy volunteers were scanned by CE-MRA in erus twice with parellel imaging factor （PIF） of 3 or 4. The signal-to-noise ratio （SNR）, contrast-to-noise ratio （CNR） and image quality of popliteal artery, posterior tibial artery, anterior tibial artery and peroneal artery were compared. Twenty patients with diabetic foot underwent CE-MRA by both of protocol 1 and 2 in leg, crus and foot. Protocol 1 was the traditional Care-bolus protocol and protocol 2 was the optimized K-space center filling delay-time protocol. The difference of two protocols in venous aliasing and in display of femoral artery, popliteal artery, posterior tibial artery, anterior tibial artery, peroneal artery, dorsalis pedis artery, medial plantar artery and lateral plantar artery were compared. The SNR, CNR of two different PIF sequences were compared by paired t test, and the display of artery of erus was compared by Wilcoxon. The display of vessels and venous aliasing of 2 protocols of diabetic foot patients were compared by Wilcoxon. Results In the images of healthy volunteers with PIF of 3, the SNR were 267±84,174±51, 147＋_42;and the CNR were 232±83,139＋-51,108＋-39 at popliteal artery, posterior tibial artery and peroneal artery. However, in the images with PIF of 4, the SNR were 239±73,157±53,132±35;and CNR were 206±71, 124±50,103±33, respectively. Both the SNR and CNR were higher in the former than in the latter（t values were 2.31 to 4.11, P〈O.05）.There was no significant difference in the vessel display between the different PIF volunteers （P〉O.O5）.In the protocol 1 of patients with diabetic foot,the display of popliteal artery, posterior tibial artery, anterior tibial artery, peroneal artery, dorsalis pedis artery, medial plantar artery and lateral plantar artery, the venous aliasing in erus and foot were 3.40±0.82, 2.70±0.80, 2.50±1.00, 2.20±0

关 键 词：糖尿病足 磁共振血管造影术 下肢 

分 类 号：R587.2[医药卫生—内分泌]