3T磁共振血管成像对糖尿病下肢大血管病变的诊断价值

The diagnostic value of 3T magnetic resonance angiography on diabetic peripheral artery disease of lower extremity

目的评价3T磁共振血管成像(3.0-Telsa magnetic resonance angiography,3T MRA)对糖尿病患者下肢动脉病变(peripheral artery disease,PAD)的诊断价值。方法根据大血管彩超结果,对下肢血管狭窄>50%的46例2型糖尿病患者做3T MRA检查,并用数字减影血管造影(digital subtraction angiography,DSA)作为对照,评价其对髂总、股、小腿和足动脉等4段血管病变诊断的意义。结果3T MRA能完整显示整个下肢PAD,对踝以上动脉血管病变显像清晰,且病变分布广泛、远端重于近端、呈多节段性狭阻。3T MRA显示的股动脉、小腿动脉的狭窄>50%病变节段数与DSA无明显差异(P=0.965,P=0.846),但其诊断的足部动脉狭阻节段数明显多于DSA(P=0.006).3T MRA诊断狭窄>50%的动脉病变的敏感度和特异度分别为:股动脉皆为100%,小腿动脉为95.62%和100%,足动脉为100%和72.22%。两种方法诊断不同节段动脉病变的κ值依次为:股动脉1.000(P<0.001),小腿动脉0.949(P<0.001),足部动脉0.635(P<0.05)。结论3T MRA可清楚显示糖尿病患者踝以上的动脉病变,对股及小腿动脉病变的诊断价值与DSA类似,但对足部动脉可能有夸大效应。

Objective To evaluate the diagnostic performance of 3. 0-Telsa magnetic resonance angiography （3T MRA） for depicting the peripheral artery disease （PAD） severity of lower extremity in type 2 diabetic patients. Methods Based on the ultrasonic artery scan, 46 patients with artery stegnosis over 50% were undertaken 3T MRA and digital subtraction angiography （DSA）. 3T MRA images of 4 artery segments were assessed and compared with images of DSA. The difference and concordance between 3T MRA and DSA imaging were evaluated by Chi-square test and kappa value. Results The image of 3T MRA showed that diabetic PAD in lower extremity was extensive and multisegmental, and the distal section was more severe than the proximal section. There was no significant difference between segment numbers with lumenus stenosis 〉50% displayed by 3T MRA and DSA in thigh （P = 0. 965） and calf （P = 0. 846）, but more segments of pedal artery were considered occlusion by 3T MRA than by DSA （P = 0. 006）. The sensitivities and specificities of 3T MRA for depicting the segments with arterial stenosis above 50% were 100% and 100% in thigh artery, 95.62% and 100% in calf artery, and 100% and 72.22 % in foot artery. The ~c value indicating the concordance between 3T MRA and DSA were 1.00 in thigh artery （P〈0. 001）, 0. 949 in calf artery （P〈0. 001）, and 0. 635 in foot artery （P = 0. 027）. Conclusions 3T MRA indicates the artery disease above ankle completely and clearly. The diagnostic accuracy of thigh and calf arteries is similar to DSA, but for foot artery there may be some exaggerating effects.