二维相位对比磁共振成像在髂静脉压迫综合征中的应用研究  

Study of 2D phase contrast magnetic resonance imaging in the diagnosis of iliac vein compressionsyndrome

作　　者：成善聪 曹新山[2] 王柱[1] 韩新强[1] CHENG Shancong;CAO Xinshan;WANG Zhu;HAN Xinqiang(Department of Interventional Medicine and Vascular Surgery,Binzhou Medical University Hospital,Binzhou 256603,China;Department of Radiology,Binzhou Medical University Hospital,Binzhou 256603,China)

机构地区：[1]滨州医学院附属医院介入血管外科,滨州256603 [2]滨州医学院附属医院放射科,滨州256603

出　　处：《磁共振成像》2025年第1期146-151,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：山东省省级临床重点专科基金项目(编号:SLCZDZK-2104)。

摘　　要：目的探讨二维相位对比(2D phase contrast,2D PC)磁共振成像(magnetic resonance imaging,MRI)序列在定量分析髂静脉压迫综合征(iliac vein compression syndrome,IVCS)患者静脉管腔内血液平均流速(mean blood flow velocity,MV)的应用价值。材料与方法前瞻性招募2023年12月到2024年7月在本院经数字减影血管造影(digital subtraction angiography,DSA)诊断明确为IVCS且需要血管腔内介入治疗的患者30例(试验组)及10名健康志愿者(对照组),收集患者临床资料并行1.5 T飞利浦超导MRI检查,在自由稳态进动(balance fast field echo,B-FFE)序列图像基础上分别在下腔静脉、双侧髂外静脉的冠状位、矢状位及轴位图上垂直扫描2D PC MRI序列,使用定量流量(quantitative flow,Q_FLOW)后处理软件得到血管垂直横切面感兴趣区(region of interest,ROI)内MV值。所有2D PC MRI检查进行两次,通过分析两次扫描结果的一致性(Bland-Altman图)来验证序列稳定性;分别比较IVCS试验组与对照组双侧髂外静脉MV值,评估IVCS患者髂总静脉受压对远端血流的影响;比较IVCS试验组(健侧髂外MV-患侧髂外MV)与对照组(右侧髂外MV-左侧髂外MV)髂外静脉MV差值,分析流速差诊断IVCS的效能;术中通过中心静脉导管(central venous catheter,CVC)测量IVCS患者组髂-下腔静脉压力梯度,并与患侧髂外静脉MV值进行相关性分析。结果两次2D PC MRI扫描结果一致性良好(P均<0.001);试验组患侧髂外静脉血液流速低于健侧(P<0.001),对照组双侧髂外静脉MV值差异没有统计学意义(P=0.518);使用双侧髂外静脉MV差值诊断IVCS效能高,AUC为0.939(95%CI:0.887~0.991),敏感度为81.7%,特异度为100.0%;术中CVC测量压力梯度结果与狭窄静脉远心端MV呈负相关(r=-0.951,P<0.001)。结论2D PC MRI定量分析IVCS患者静脉血液流速结果稳定、可靠,双侧髂外静脉MV差值诊断IVCS特异性高,IVCS患者髂外静脉MV值与髂-下腔静脉压力梯度符合伯努利原理,2D PCObjective:To investigate the value of 2D phase contrast magnetic resonance imaging(PC MRI)in quantitative analysis of mean blood flow velocity(MV)in patients with iliac vein compression syndrome(IVCS).Materials and Methods:Thirty patients(trial group)with IVCS diagnosed by digital subtraction angiography(DSA)in interventional vascular surgery from December 2023 to July 2024 and ten healthy volunteers(control group)were collected.Clinical data of patients were collected and Philips superconducting MRI 1.5 T was performed.On the basis of balance fast field echo(B-FFE)sequences,2D PC MRI were set vertically on the coronal,sagittal and axial images of the inferior vena cava and both of external iliac vein.The MV values in the region of interest(ROI)in the vertical cross section of the vessels were obtained by using quantitative flow(Q_FLOW)post-processing software.All 2D PC MRI checks forward twice,and the sequence stability is verified by analyzing the consistency of the two scan results(Bland-Altman diagram).Comparing the MV value between both of external iliac veins in two groups to assesses the effect of common iliac vein compression on blood flow.The MV difference of bilateral external iliac veins in the trial group(healthy external iliac MV-affected external iliac MV)was compared with that in the control group(right external iliac MV-left external iliac MV),and the efficacy of velocity difference in diagnosing IVCS was analyzed.The iliac-vena cava pressure gradient measured by central venous catheter(CVC)in interventional procedures was analyzed in correlation with MV in the distal part of the stenosed iliac vein.Results:The results of the two scans were highly positively correlated(P<0.001,all).The MV of the narrow iliac vein was lower than that of the healthy side in the trial group(P<0.001),and the MV values of bilateral external iliac veins in the control group were not statistically significant(P=0.518).The MV difference of bilateral external iliac veins was effective in the diagnosis of IVCS,the AUC was 0

关 键 词：髂静脉压迫综合征 二维相位对比 血液流速 压力梯度 血管内介入 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R543.6[医药卫生—诊断学]