流入翻转恢复非对比剂增强磁共振血管成像序列评估移植肾动脉狭窄的研究  

Evaluation of vascular stenosis of renal transplantation by non-contrast enhanced MR angiography using in-flow inversion recovery pulses

作　　者：张军[1] 孙晶[1] 谢媛[1] 李延军[1] 王朋[1] 郑玲[1] ZHANG Jun;SUN Jing;XIE Yuan;LI Yanjun;WANG Peng;ZHENG Ling(The Department of Radiology,Nanjing General Hospital of Nanjing Military Command,PLA,Nanjing 210002,P.R.China)

机构地区：[1]中国人民解放军南京军区南京总医院医学影像科,江苏南京210002

出　　处：《医学影像学杂志》2018年第8期1317-1321,共5页Journal of Medical Imaging

基　　金：国家自然科学基金青年科学基金项目(编号:81701770)

摘　　要：目的与数字减影血管造影(DSA)相比较,探讨流入翻转恢复序列磁共振血管成像(IFIR-MRA)技术对移植肾动脉狭窄的临床应用价值。方法对超声怀疑血管狭窄的32例肾移植术患者行DSA检查和流入翻转恢复非对比剂增强磁共振血管成像检查,获取移植肾动脉血管的解剖图像;由2位放射医师对磁共振血管的图像进行技术评分,以DSA为金标准,并将IFIR的结果与DSA结果进行对照分析。结果 32例肾移植患者行磁共振IFIR序列扫描,图像质量评分为优秀占88%(28/32),中等的占3%(1/32),一般的占3%(1/32),差的6%(2/32)。经DSA证实移植肾动脉狭窄的30例(2例患者磁共振检查配合欠佳图像较差无法进行临床评价)中:轻度狭窄10例,中度狭窄14例,重度狭窄6例;但IFIR序列扫描有1例轻度狭窄被过高评估为中度,有1例中度狭窄被过高评估为重度。两种成像方法相比较磁共振有时会过高估计狭窄程度,但差异没有统计学意义(P> 0. 05),在评估移植肾动脉狭窄程度方面与DSA具有很好的一致性。结论 IFIR成像技术无创伤、没有电离辐射,无需使用对比剂,可以为临床怀疑移植肾动脉血管狭窄的患者做出可靠诊断,为临床治疗方案提供重要依据。Objective To investigate the clinical value of in-flow inversion recovery pulses for the detection of renal transplantation artery stenosis,in comparison with digital subtraction angiography（DSA） as the reference standard. Methods Both IFIR and DSA examinations were performed on 32 patients with suspected renal artery stenosis after transplantation,who were diagnosed according to ultrasonography results. Anatomic angiographic images from MRI were reconstructed. With DSA as the reference,the imaging quality and renal artery stenosis after transplantation grades were independently evaluated by two radiologists. Results32 renal transplant patients underwent MR IFIR examination and were divided into four groups according to the image quality： excellent（88%,28/32）,medium（3%,1/32）,general（3%,1/32） and poor（6%,2/32）. In the 30 patients who were diagnosed as renal artery stenosis by DSA（2 cases were not suitable for clinical evaluation due to the poor imaging quality）,mild stenosis accounted for 33. 33%（10/30）,moderate stenosis accounted for 46. 67%（14/30） and severe stenosis accounted for 20%（6/30）. One patient with mild stenosis was diagnosed as moderate and one moderate stenosis case was diagnosed as severe with MR IFIR sequence. Although sometimes the degree of stenosis was accessed higher by MRI,there was no statistically significant difference between MRI IFIR and DSA（P〉0. 05） and there was a good agreement in assessing the degree of renal artery stenosis. Conclusion Non-enhanced MRA using IFIR was a non-invasive approach and without radiation damage. MRI IFIR could be used to diagnose transplant renal artery stenosis accurately and help the clinic to reliably establish therapy project.

关 键 词：移植肾 肾动脉狭窄 流入翻转恢复序列 磁共振成像 

分 类 号：R692[医药卫生—泌尿科学] R445.2[医药卫生—外科学]