FSD-bSSFP非增强MRA手部动脉病变诊断的初步研究

Non-contrast MR angiography with balanced steady-state free precession based on flow-sensitive dephasing：a preliminary study in hand arterial diseases

目的：评价非增强磁共振血管成像平衡稳态自由进动序列（FSD-bSSFP）对类风湿性关节炎患者手部动脉血管病变的临床诊断价值。方法采用非增强磁共振序列FSD-bSSFP以及增强磁共振序列CEMRA分别对广州市番禺区中心医院、深圳北大医院2014年10月至2015年10月共24名经临床确诊的类风湿性关节炎患者的手动脉进行扫描，比较分析扫描图像的质量、狭窄程度、信噪比（SNR）和对比信噪比（CNR），进行前瞻性研究。结果24名患者均成功进行FSD、CEMRA扫描，共192个血管节段。FSD与CEMRA显示血管的条数分别为165条（165/192，86%）、125条（125/192，65%），两组具有统计学意义（P=0.000）。图像质量评估积分中，平均积分FSD（2.33±1.05）vs CEMRA （3.56±0.90）；各血管节段积分FSD序列均低于CEMRA序列（P=0.001）。FSD与CEMRA序列各血管分支的SNR差异具有统计学意义（P=0.019）。结论在评价类风湿性关节炎患者的手动脉血管病变诊断价值方面，新兴的非增强FSD-bSSFP扫描序列在图像质量优于CEMRA，可作为肾功能不全患者一种有效的补充方法。

Objective To evaluate the diagnostic value of non-enhanced MR angiography with balanced steady-state free precession based on flow-sensitive dephasing （FSD-bSSFP） in hand arterial diseases of patients with rheumatoid arthritis. Methods Non-enhanced MR with FSD-bSSFP sequence and enhanced MR with CEMRA sequence were used to scan the hand arteries of 24 patients with clinically confirmed rheumatoid arthritis in Guangzhou Panyu District Central Hospital and Peking University Shenzhen Hospital between October 2014 and October 2015. The quality of scanned images,severity of arterial stenosis,signal to noise ratio （SNR） and contrast-noise ratio （CNR） in these patients were compared prospectively. Results Twenty-four patients underwent successful MR scan with FSD and CEMRA sequences of totally 192 vascular segments. FSD scan visualized 165 （165/192,86%） blood vessels, compared with 125（125/192,65%）by CEMRA scan,with statistically significant difference between the two sequences（P=0.000）. Evaluation of image quality showed that a mean score of 2.33 ± 1.05 by FSD scan vs 3.56 ± 0.90 by CEMRA scan,and a lower score at each vessel segments by FSD sequence compared with CEMRA sequence （P=0.001）. There was a significant difference in SNR between FSD and CEMRA sequence at each vessel branches （P=0.019）. Conclusion In patients with rheumatoid arthritis,the value of the newly-introduced non-enhanced MR angiography with FSD-bSSFP sequence is superior to CEMRA in diagnosing hand arterial diseases,and can be a useful alternative MRA method in patients with renal insufficiency.