非增强MRA对下肢动脉硬化闭塞症膝下动脉的评价:与增强MRA和DSA作对照  

Evaluation of calf arteries in arteriosclerotic occlusive disease by NCE MRA:comparison with CE MRA and DSA

作　　者：刘家祎[1] 张楠[1] 罗南[1] 陈忠[2] 温兆赢[1] 范占明[1] 

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,北京100029 [2]首都医科大学附属北京安贞医院血管外科,北京100029

出　　处：《医学影像学杂志》2017年第6期1005-1010,共6页Journal of Medical Imaging

基　　金：国家自然科学基金资助项目(编号:81401375);北京自然科学基金资助项目(编号:7142047)

摘　　要：目的探讨非增强磁共振血管造影(MRA)评价下肢动脉硬化闭塞症膝下动脉病变通畅性及累及程度和范围的应用价值。方法连续性入组45例跛行患者,行静息踝肱指数测量,其中21例患者ABI小于0.9,进一步行非增强MRA、增强MRA和数字减影血管造影(DSA)检查,共计27条下肢,以DSA作为标准,重点对腘动脉、胫腓干、胫前动脉、胫后动脉、腓动脉,共135个节段进行分析。结果共观察135个动脉节段。非增强MRA显示99通畅,增强MRA显示96通畅,DSA显示101通畅。非增强MRA与增强MRA、DSA比较观察血管通畅性一致性良好(Kappa>0.85,P<0.001)。对于狭窄≥50%动脉的判断无明显统计学差异(P>0.05)。三种检查均存在的狭窄程度≥50%的血管节段共计15个。非增强MRA与增强MRA、DSA比较,对狭窄长度的测量存在明显统计学差异(P<0.05)。结论非增强MRA在观察血管通畅性、识别血管有无狭窄方面与增强MRA及DSA基本等同,显示血管受累范围较增强MRA准确,是诊断下肢血管病变的一种可靠方法,但对血管狭窄程度有过度评估的倾向。当患者存在肾功能不全时,非增强MRA可以替代DSA和增强MRA,成为此类患者术前血管评估的可靠手段。Objective To investigate the application value of non-enhanced magnetic resonance angiography（ MRA） in the evaluation of the patency,involvement degree,and range of calf arterial lesions in arteriosclerotic occlusive diseases of lower extremities. Methods ABI was measured in 45 patients with claudication. 21 patients with ABI lower than 0. 9 received non-enhanced MRA,enhanced MRA,and digital subtraction angiography（ DSA） examinations. Using DSA as the standard,27 lower extremities with a focus on 135 segments including the popliteal artery,tibial-fibular trunk,anterior tibial artery,posterior tibial artery,and fibular artery were analyzed. Results Among total 135 segements,99 patency arterial segments was shown in nonenhanced MRA,96 patency segments in enhanced MRA and 101 patency segments in DSA. A comparison among non-enhanced MRA,enhanced MRA,and DSA showed that the consistency of observation of vascular patency was excellent（ Kappa 0. 85,P〈0. 001）. The determination of arteries with stenosis ≥50% did not display a statistically significant difference（ P〈0. 05）. A total of 15 vascular segments with stenosis ≥50% were present in all three examinations. Measurement of lesion length using nonenhanced MRA,enhanced MRA,and DSA was significantly difference（ P〈0. 01）. Conclusion Non-enhanced MRA was similar to enhanced MRA and DSA for observing vascular patency and recognizing vascular stenosis; in addition,it was more accurate than enhanced MRA for displaying the range of vascular involvement. Therefore,non-enhanced MRA was a reliable method for diagnosing vascular diseases in the lower extremities. However,it had a tendency to over-evaluate the degree of vascular stenosis. When patients had renal insufficiency,non-enhanced MRA could replace DSA and enhanced MRA; therefore,it represents a reliable method for pre-operative vascular evaluation of this group of patients.

关 键 词：下肢血管 磁共振血管造影 数字减影血管造影 

分 类 号：R552[医药卫生—血液循环系统疾病] R445.2[医药卫生—内科学]