磁共振成像与数字减影造影诊断布加综合征下腔静脉病变的比较

Magnetic resonance angiography versus digital subtraction angiography in diagnosing inferior vena cava diseases of Budd-Chiari syndrome

目的探讨三维动态增强磁共振血管成像（3D DCE MRA）和数字减影血管造影（DSA）对疑似布加综合征（BCS）患者下腔静脉病变的诊断能力。方法回顾性分析91例入住徐州医科大学附属医院前疑似BCS综合征患者的3D DCE MRA和DSA的影像学资料。以DSA检查作为金标准，评估3D DCE MRA对下腔静脉病变的诊断能力，包括检出下腔静脉病变的敏感度、特异度及诊断准确度。采用Kappa检验评估两种方法诊断下腔静脉病变的一致性。结果91例患者中，3D DCE MRA将17例无下腔静脉病变患者诊断为下腔静脉狭窄，2例下腔静脉闭塞患者诊断为阴性。3D DCE MRA正确诊断72例，发现下腔静脉病变的敏感度为97．7％（58／60），假阳性率为54．8％（17／31），特异度为45．2％（14／31），与DSA诊断存在中度一致性（Kappa=0．474，P〈0．05）。结论3D DCE MRA诊断下腔静脉病变的敏感度高、特异度较低，与DSA的一致性较为理想，对BCS患者分型诊断具有一定的参考价值。对3D DCE MRA怀疑下腔静脉狭窄的患者应全面观察图像，进一步分析可能存在导致误诊的原因，降低假阳性率。

Objective To compare the clinical value of three-dimensional dynamic contrast en- hanced magnetic resonance angiography （3D DCE MRA） and digital subtraction angiography （DSA） in diagnosing inferior vena cava diseases in suspected case of Budd-Chiari syndrome （BCS）. Methods Radiological findings of 91 suspected BCS cases obtained from 3D DCE MRA and DSA in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. DSA test was considered as golden standard, which assess the capacity of 3D DCE MRA in diagnosing inferior vena cava diseases, including sensitivity, specificity and accuracy. Kappa test was utilized to compare the coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases. Results Among 91 suspected BCS cases with 3D DCE MRA, a total of 17 cases without inferior vena cava diseases were misdiagnosed as inferior vena cava stenosis, two pa- tients with inferior vena caval obstruction was misdiagnosed as falsely negative. Seventy-two patients with 3D DCE MRA were confirmed via DSA in diagnosing inferior vena cava diseases, sensitivity was up to 97.7% （58/60）, false positivity 54.8% （ 17/31 ）, specificity 45.2% （ 14/31 ）, respectively. Fair coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases （ Kappa = 0.474, P 〈 0.05 ）. Conclusions There could be clinical value of 3D DCE MRA for its high sensitivity and low specificity in diagnosing inferior vena cava diseases, and favorable coincidence ratio was discovered between 3D DCE MRA and DSA. Comprehensive consideration is needed for suspected cases of inferior vena cava stenosis detected by 3D DCE MRA, and further analysis may figure out potential causes of misdiagnosis and decline false positive events.