磁共振成像在儿童胡桃夹综合征中的诊断价值  

Diagnostic potential of magnetic resonance imaging in children with nutcracker syndrome

作　　者：王忍 王美秋 夏正坤 张沛 高春林 Wang Ren;Wang Meiqiu;Xia Zhengkun;Zhang Pei;Gao Chunlin(Department of Pediatrics,General Hospital of Eastern Theater Command,Nanjing 210002,China;Department of Pediatrics,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China)

机构地区：[1]东部战区总医院儿科,南京210002 [2]南京大学医学院附属金陵医院儿科,南京210002

出　　处：《中华实用儿科临床杂志》2023年第6期448-451,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：江苏省儿科医学创新团队项目(CXTDA2017022);江苏省自然科学基金青年基金项目(BK20190251)。

摘　　要：目的探讨磁共振成像(MRI)在儿童胡桃夹综合征(NCS)中的诊断价值。方法回顾性分析2017年1月至2020年7月就诊于东部战区总医院儿科疑似NCS的患儿(155例)。疑似NCS的诊断主要基于临床症状或体征、实验室检查和影像学报告,其他可能导致血尿和/或蛋白尿的疾病被排除在外。患儿均行MRI检查,根据NCS的诊断标准,将左肾静脉(LRV)受压且符合NCS诊断的患儿纳入胡桃夹组(58例),LRV未受压及LRV受压但不符合NCS诊断的患儿纳入对照组(97例)。采用t检验、Mann-Whitney U检验和χ^(2)检验比较胡桃夹组和对照组患儿的基线特征、临床特征和影像学特征。构建受试者工作特征曲线,探索MRI在儿童NCS中的诊断价值。结果1.肠系膜上动脉(SMA)夹角、压缩比(CR)和鸟嘴征在NCS诊断中的曲线下面积分别为0.870、0.895和0.878。2.SMA夹角和CR的最佳截断值分别为36.8°和3.99。3.SMA夹角<36.8°、鸟嘴征、CR>3.99、SMA夹角<36.8°和鸟嘴征、SMA夹角<36.8°和CR>3.99及鸟嘴征和CR>3.99诊断NCS的特异度分别为82.5%、93.8%、93.5%、97.9%、95.9%和97.9%。结论MRI表现SMA夹角<36.8°、鸟嘴征、CR>3.99的儿童应高度怀疑NCS,其中鸟嘴征诊断NCS的特异度最高,且任意两个参数的组合较单一参数有更高的特异度。Objective To explore the diagnostic potential of magnetic resonance imaging(MRI)in children with nutcracker syndrome(NCS).Methods A retrospective analysis was performed in patients with suspected NCS(155 cases)diagnosed in the Department of Pediatrics,General Hospital of Eastern Theater Command from January 2017 to July 2020.Suspected NCS was diagnosed primarily based on clinical signs or symptoms,laboratory testing,and imaging reports,and other conditions that may cause hematuria and/or proteinuria were excluded.MRI examination was performed in all patients.According to the diagnostic criteria of NCS,patients diagnosed as NCS with the compression of the left renal vein(LRV)were included in the NCS group(58 cases),and those without the compression of the LRV or with the compression of the LRV but was not consistent with the diagnosis of NCS were included in the control group(97 cases).t test,Mann-Whitney U test andχ^(2) test were used to compare the baseline characteristics,clinical characteristics and imaging characteristics of the children in the nutcracker group and the control group.Receiver operating characteristic curves were plotted to explore the diagnostic potential of MRI in children with NCS.Results(1)The area under curve of the angle between the superior mesenteric artery(SMA)and the aorta,compression ratio(CR)and beak sign in diagnosing NCS in children were 0.870,0.895 and 0.878,respectively.(2)The optimal cut-off values of the angle between the SMA and the aorta and CR were 36.8°and 3.99,respectively.(3)The specificity of the angle between the SMA and the aorta<36.8°,beak sign,CR>3.99,the angle between the SMA and the aorta combined with beak sign,the angle between the SMA and the aorta<36.8°combined with CR>3.99,and beak sign combined with CR>3.99 in diagnosing NCS in children were 82.5%,93.8%,93.5%,97.9%,95.9%and 97.9%,respectively.Conclusions Children with the angle between the SMA and the aorta<36.8°,beak sign and CR>3.99 suggested on MRI scans should be highly suspected of NCS.The beak sig

关 键 词：左肾静脉 磁共振成像 儿童 胡桃夹综合征 

分 类 号：R445.2[医药卫生—影像医学与核医学] R726.9[医药卫生—诊断学]