非增强磁共振血管成像对糖尿病下肢动脉狭窄的诊断价值

Diagnostic Value of Non-contrast Enhanced Magnetic Resonance Angiography for Diabetic Lower Extremity Arterial Stenosis

目的前瞻性评估非增强磁共振血管成像(NCE-MRA)诊断糖尿病下肢动脉狭窄的价值。资料与方法 45例糖尿病患者拟行下肢动脉增强磁共振血管成像(CE-MRA),使用1.5TMRI对患者小腿动脉行NCE-MRA。以CE-MRA为标准,由2名观察者对NCE-MRA的图像质量和诊断显著性狭窄(≥50%)的准确度进行评估。结果 3支小腿动脉(胫前动脉、胫后动脉和腓动脉)中,NCE-MRA具有诊断价值的动脉节段数有258个,图像质量评分为(3.3±0.6)分;CE-MRA具有诊断价值的动脉节段数有260个,图像质量评分为(3.5±0.7)分,差异有统计学意义(Z=4.24,P<0.01)。NCE-MRA诊断下肢动脉显著性狭窄(≥50%)的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为96.73%、96.72%、96.73%、90.08%、98.97%,2名观察者对小腿动脉狭窄的诊断一致性较好(Kappa=0.95)。结论 NCE-MRA在显示糖尿病患者下肢动脉狭窄方面与CE-MRA具有相近的图像质量和诊断准确度,可以作为糖尿病肾功能不全患者下肢动脉磁共振造影的替代检查方法。

Purpose To prospectively explore the diagnostic value of non-contrast enhanced magnetic resonance angiography （NCE-MRA） for diabetic lower extremity arterial stenosis. Materials and Methods Forty-five patients with diabetes mellitus and were scheduled for contrast enhanced magnetic resonance angiography （CE-MRA） lbr lower extremity arterial evaluation underwent calf artery NCE-MRA using a 1.5T MRI scanner. Image quality and the accuracy to diagnose significant stenosis （ 〉 50%） of NCE- MRA were assessed by two observers with CE-MRA as reference standard. Results In NCE-MRA, 258 diagnostic valuable arterial segments were portrayed for three calf arteries （anterior tibial artery, posterior tibial artery and peroneal artery）, with image quality score of （3.3 4-0.6） points; in CE-MRA, 260 diagnostic valuable arterial segments were portrayed, with image quality score of （3.5 ~ 0.7） points, there was statistically significant difference （Z=4.24, P〈0.01） between the two methods. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of NCE-MRA for the diagnosis of significant（ ≥50%） lower extremity arterial stenosis were 96.73%, 96.72%, 96.73%, 90.08% and 98.97%, respectively, and there was content agreement （Kappa=0.95） between the two observers for the diagnosis of calf artery stenosis. Conclusion For the imaging of lower extremity arterial stenosis in diabetic patients, NCE-MRA shows similar image quality and diagnostic accuracy with CE-MRA, thus can be used as an alternative method for lower extremity CE-MRA in diabetic patients with renal insufficiency.