3D动态增强磁共振血管成像在食道静脉曲张患者中的应用  

Application of three-dimensional dynamic entrastenhanced magnetic resonance angiography in patients with esophageal varicose veins

作　　者：钟向阳[1] 陈相猛[1] 卢冬莹 李政 麦栩榆[1] 陈美容[1] ZHONG Xiang-yang;CHEN Xiang-meng;LU Dong-ying(Department of Radiology,Jiangmen Central Hospital,Jiangmen Guangdong 529000,China)

机构地区：[1]江门市中心医院放射科,广东江门529000

出　　处：《临床和实验医学杂志》2023年第11期1207-1211,共5页Journal of Clinical and Experimental Medicine

基　　金：广东省医学科学技术研究基金项目(编号:A2021138);2022年江门市计划科技项目(编号:2022YL01004)。

摘　　要：目的探讨3D动态增强磁共振血管成像(3D DCE MRA)在食道静脉曲张患者中的应用。方法前瞻性选取2021年1月至2023年1月江门市中心医院收治的肝硬化患者60例作为研究对象。所有患者均行CT门静脉成像(CTP)和3D DCE MRA检查。采用ROC曲线下面积(AUC)评估各参数诊断有无GEV及GEV分级的价值。结果GEV 0级13例,GEV 1级21例,GEV 2级20例,GEV 3级6例。不同GEV分级在不同年龄亚组和性别亚组中差异无统计学意义(P>0.05),不同GEV分级在CTP分级和3D DCE MRA分级差异有统计学意义(P<0.05)。Spearman相关性分析结果显示,CTP分级、3D DCE MRA分级与内镜下GEV分级显著相关(P<0.05)。2名医师3D DCE MRA分级结果与内镜结果的Kapppa值为0.743[95%CI(0.612~0.895)];CTP诊断GEV的敏感度和特异度为70.00%和69.00%;3D DCE MRA分级诊断GEV的敏感度和特异度为78.00%和76.00%;联合诊断GEV的敏感度和特异度为88.00%和90.00%;CTP诊断GEV分级的敏感度和特异度为74.00%和78.00%;3D DCE MRA诊断GEV分级的敏感度和特异度为80.00%和80.00%;联合诊断GEV分级的敏感度和特异度为92.00%和95.00%。结论相较于CTP检查,3D DCE MRA对GEV的鉴别诊断和分级评估具有更高的敏感度和特异度,临床可在采用CTP初步筛查后针对高风险群体联合3D DCE MRA作为罹患GEV高风险群体患者病情诊断及分级的无创、便捷方案,从而有效提高临床GEV的诊断准确率,并降低因GEV发生和病情进展造成的患者预后不良风险并进一步改善预后。Objective To investigate the application of three-dimensional dynamic entrastenhanced magnetic resonance angiography(3D DCE MRA)in patients with esophageal varicose veins.Methods Sixty patients with cirrhosis admitted to Jiangmen Central Hospital from January 2021 to January 2023 were prospectively selected as research objects.CT portography(CTP)and 3D DCE MRA were performed in all patients.The value of GEV diagnosis and GEV classification was evaluated by receiver operating characteristic area under the curve(AUC).Results There were 13 cases of GEV 0 grade,21 cases of GEV 1 grade,20 cases of GEV 2 grade,and 6 cases of GEV 3 grade.There were no statistically significant differences among different GEV grades in different age subgroups and gender subgroups(P>0.05),but there were statistically significant differences among different GEV grades in CTP grades and 3D DCE MRA grades(P<0.05).Spearman correlation analysis showed that CTP grading,3D DCE MRA grading were significantly correlated with endoscopic GEV grading(P<0.05).The Kapppa values of 3D DCE MRA grading results and endoscopic results of 2 physicians were 0.743[95%CI(0.612-0.895)].The sensitivity and specificity of CTP in the diagnosis of GEV were 70.00%and 69.00%.The sensitivity and specificity of 3D DCE MRA in the diagnosis of GEV were 78.00%and 76.00%.The sensitivity and specificity of GEV were 88.00%and 90.00%.The sensitivity and specificity of CTP in the diagnosis of GEV were 74.00%and 78.00%.The sensitivity and specificity of 3D DCE MRA were 80.00%and 80.00%respectively.The sensitivity and specificity of the fitted GEV classification were 92.00%and 95.00%.Conclusion Compared to CTP examination,3D DCE MRA has higher sensitivity and specificity in the differential diagnosis and grading evaluation of GEV.In clinical practice,3D DCE MRA can be combined with CTP preliminary screening for high-risk groups as a non-invasive and convenient plan for the diagnosis and grading of GEV patients in high-risk groups,thereby effectively improving the diagnostic accur

关 键 词：3D动态增强磁共振血管成像 CT门静脉血管成像 食道静脉曲张 

分 类 号：R445.2[医药卫生—影像医学与核医学] R57[医药卫生—诊断学]