mDIXON序列 3.0T MRA诊断中心静脉病变:与DSA对照研究  

Application of mDIXON technique contrast-enhanced MR angiography with 3.0T MR scanner in diagnosis of central venous diseases: a comparative study with DSA

作　　者：陶黎[1] 朱嵬 张晓宇 左子钰 刘传[1] 杨柳[1] 方维东[1] 吴治峄 TAO Li;ZHU Wei;ZHANG Xiao-Yu(Department of Radiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院放射科,重庆400016 [2]中国科学院北京纳米能源与系统研究所,北京100084

出　　处：《放射学实践》2022年第4期514-519,共6页Radiologic Practice

基　　金：国家自然科学基金(81671663)。

摘　　要：目的:探讨改良水脂分离技术(mDIXON)对比增强3.0T MRA在诊断血液透析患者中心静脉病变中的可行性及应用价值。方法:40例有上肢肿胀、胸壁静脉曲张、内瘘假性动脉瘤等临床症状的中心静脉病变患者在行DSA检查前采用mDIXON技术行CE-MRA检查。由2位MRI医师根据4分法,分别对图像质量进行评分;并根据4级评分标准,对中心静脉的狭窄程度进行评估。采用Kappa检验分析2位MRI医师对图像质量评分、mDIXON CE-MRA和DSA对中心静脉狭窄程度的分级及判断闭塞与非闭塞性病变的一致性。以DSA为金标准,计算mDIXON CE-MRA诊断中心静脉闭塞和非闭塞病变的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。结果:两位MRI医师对中心静脉图像质量评分、mDIXON CE-MRA与DSA对中心静脉狭窄程度的分级及诊断闭塞病变和非闭塞病变的一致性均较好,Kappa值为分别0.655、0.921和1.000(P值均<0.05)。mDIXON CE-MRA评估中心静脉狭窄程度的符合率为94.74%(36/38),对狭窄程度分级高估率为5.26%(2/38)。mDIXON CE-MRA诊断中心静脉闭塞病变的敏感度、特异度、PPV和NPV均为100%;诊断非闭塞病变的敏感度、特异度、PPV和NPV分别为100%、75%、93%和100%。结论:mDIXON CE-MRA能够清晰显示中心静脉狭窄病变,具有较高的图像质量和诊断准确性,可作为一种可靠的替代检查方法及术前评估手段。Objective:To investigate the feasibility and value of contrast enhanced MR angiography(CE-MRA)using modified DIXON(mDIXON)technique at a 3.0T MR scanner in the diagnosis of central venous diseases in hemodialysis patients.Methods:40 patients with central venous diseases with clinical symptoms such as upper limb swelling,chest wall varicose veins,and internal fistula pseudoaneurysm underwent mDIXON CE-MRA examination before digital subtraction angiography(DSA)examination.The image quality of mDIXON CE-MRA was scored according to the 4-point method and the degree of central venous stenosis was evaluated according to the 4-grade scoring stan-dard by two radiologists respectively.Kappa test was used to analyze the consistency of image quality score,grade of central venous stenosis and detection of occlusive and non-occlusive lesions by mDIXON CE-MRA and DSA.Sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of mDIXON CE-MRA in diagnosis of occlusive and non-occlusive lesions of central venous were calculated using DSA as the gold standard.Results:The image quality score of central vein,central vein stenosis grade and detection of occlusive and non-occlusive lesions were in good consistency between mDIXON CE-MRA and DSA,with Kappa value of 0.655,0.921 and 1.000 respectively(all P<0.05).The diagnostic accuracy of mDIXON CE-MRA for different grades of central venous stenosis was 94.74%(36/38),and the overestimation rate of stenosis grade was 5.26%(2/38).The sensitivity,specificity,PPV and NPV of mDIXON CE-MRA in evaluating the occlusive lesions of central venous were all 100%.The sensitivity,specificity,PPV and NPV of mDIXON CE-MRA in evaluating the non-occlusive lesions of central venous were 100%,75%,93%and 100%,respectively.Conclusion:mDIXON CE-MRA can clearly display central venous stenosis withsatisfied image quality and diagnostic accuracy,and can be used as a reliable alternative exam and preoperative evaluation method.

关 键 词：磁共振血管成像 水脂分离技术 数字减影血管造影 中心静脉病变 

分 类 号：R543.6[医药卫生—心血管疾病] R445.2[医药卫生—内科学]