三维动态对比增强磁共振血管成像诊断下肢动脉硬化闭塞症的应用价值

The Application Value of 3D CE-MRA in Diagnosis on Lower Extremity Atherosclerosis Disease

目的:探讨三维动态对比增强磁共振血管成像(3D CE-MRA)在诊断下肢动脉硬化闭塞症(LEASD)中的应用价值。方法:收集临床诊断为LEASD的64例患者行下肢动脉3D CE-MRA及数字减影血管造影(DSA)检查,分析两者结果是否有差异。结果:以DSA金标准作为对照组,3D CE-MRA对下肢动脉狭窄及闭塞程度的分级与DSA比较,Kappa值为0.84≥0.75,一致性较好,差异无统计学意义(P>0.05);但3D CE-MRA对下肢动脉狭窄及闭塞有一定程度的高估及低估,对轻度狭窄、中度狭窄、重度狭窄的高估率分别为3.3%(11/332)、4.0%(5/125)、4.5%(5/112)。对中度狭窄、重度狭窄及闭塞的低估率分别为9.6%(12/125)、4.0%(5/112)、15%(20/132)。以DSA为标准,3D CE-MRA诊断下肢动脉狭窄及闭塞的敏感性、特异性、阳性预测值及阴性预测值分别为93.7%(701/753)、93.1%(563/605)、95.1%(701/737)、94.9%(563/599)。结论:3D CE-MRA下肢动脉成像是一种无创、无辐射、有效的血管检查方法,可作为LEASD的优选检查方法。

Objective： To investigate the application value of 3D CE-MRA in diagnosis of atherosclerosis occlusive disease of lower extremity. Methods： 64 patients which were diagnosed as LEASD by clinic underwent both 3D CE-MRA and DSA examination of bilateral arteries of lower extremity, and were analyzed if there were any difference between the results. Results： Taken DSA as the golden standard, the detection rate and grade of 3D CE-MRA in lower extremity artery stenosis and occlusion was compared with DSA. The value of Kappa 0. 84 ≥ 0. 75 and showed a good consistency with no statistical significance（P 0. 05）. However, diagnosis of 3D CE-MRA in lower extremity artery stenosis and occlusion had over-estimation and under-estimation to some extent. The rate of over-estimation for slight stenosis, moderate stenosis, sever stenosis were respectively 3.3%（11/332）, 4.0%（5/125）, 4.5%（5/112）. The rate of under-estimation for moderate stenosis, sever stenosis, occlusion were respectively 9.6%（12/125）, 4.0%（5/112）, 15%（20/132）. Taken DSA as the standard, the sensitivity, specificity and positive predictive value and negative predictive value of 3D CE-MRA in lower extremity artery stenosis and occlusion were 93.7%（701/753）, 93.1%（563/605）, 95.1%（701/737）, 94.9%（563/599）. Conclusion： 3D CE-MRA of lower extremity artery is a nontraumatic, nonradioactive and effective vascular examination. It could be the optimizing examination for LEASD.