非对比增强磁共振血管成像对肾动脉狭窄的诊断价值

发布时间：2018-04-09 12:44

本文选题：肾动脉狭窄　切入点：肾动脉　出处：《昆明医科大学》2014年硕士论文

【摘要】：目的1.探索非增强MRA (NCE-MRA)序列进行肾动脉成像的最佳扫描参数； 2.评价肾动NCE-MRA的图像质量； 3.以对比增强MRA(CE-MRA)为参照,评估NCE-MRA检测肾动脉狭窄的能力。材料和方法搜集我院2012年7月～2014年4月临床诊断为高血压、需行肾动脉MR检查的患者30例(男18例,女12例,年龄14-81岁,平均年龄40岁),排除MR检查禁忌症后,在同一MR设备上先后行肾动且NCE-MRA及CE-MRA检查。使用美国GE公司Signa1.5TMR.超导扫描仪、8通道TORSOPA体部线圈。摆好患者体位后,先行呼吸触发3D反转恢复稳态自由进动序列,扫描范围需包括双侧肾脏,轴位成像,成像时间约3.5-4.5min。再行快速扰相梯度回波CE-MRA序列,扫描范围包括双侧肾脏及腹主动脉,行3D冠状位成像,注射钆造影剂后约14-20s,嘱患者屏气进行肾脏血管3期图像采集,每期用时约12s。所有原始数据采用AW4.4图像处理软件进行重建和分析。分析NCE-MRA与CE-MRA在：①清晰显示肾动脉数量和种类方面有无统计学差异；②显示肾动脉分支血管能力的相关性：③肾动脉成像质量(是否满足诊断要求)上的相关性；④诊断肾动脉狭窄方面的相关性,以CE-MRA为标准,计算NCE-MRA诊断肾动脉狭窄的灵敏度、特异度、阳性预测值、阴性预测值、准确率、误诊率及漏诊率。结果 1. NCE-MRA与CE-MRA序列清晰显示肾动脉的数量及种类 30例病例中,NCE-MRA可清晰显示肾动脉60条,其中59条主肾动脉,1条副肾动脉(副肾动脉指除主肾动脉外,不经肾门,单独穿入肾实质的动脉),CE-MRA可清晰显示肾动脉59条,主肾动脉58条,副肾动脉1条。利用配对资料的x2检验,NCE-MRA与CE-MRA在清晰显示肾动脉数量上无统计学差异(P0.05)；经Fisher精确检验,P0.05, NCE-MRA和CE-MRA在清晰显示的肾动脉种类方面亦无统计学差异。 2. NCE-MRA与CE-MRA序列对肾动脉分支血管的显示 30例病例61条肾动脉中,NCE-MRA仅显示主干者4条(6.56%),显示到1级分支者9条(14.75%),显示到2级分支的有12条(19.67%),显示到3级分支者36条(59.02%); CE-MRA仅显示肾动脉主干的有4条(6.56%),显示到1级分支者9条(14.75%),显示到2级分支者14条(22.95%),显示到3级分支的有34条(55.74%)。行Spearman相关分析,两种检查方法显示肾动脉分支血管的能力呈显著相关(r=0.547,P0.01)。 3. NCE-MRA与CE-MRA肾动脉图像质量(是否满足诊断要求)比较肾动脉图像质量按照0(图像质量极差)-4(图像质量优秀)分计分。以肾动脉为单位,NCE-MRA图像质量获得0、1、2、3、4分的肾动脉分别为0条、0条、3条(4.92%)、20条(32.79%)、38条(62.29%), CE-MRA则分别为0条、2条(3.28%)、2条(3.28%)、21条(34.42%)、36条(59.02%), NCE-MRA图像全部满足诊断要求,CE-MRA有1例患者的2条肾动脉伪影重(得1分),不能作出诊断。经Spearman等级相关分析,在肾动脉的成像质量方面,NCE-MRA与CE-MRA一致性好(r=0.868,p0.01)。 4. NCE-MRA与CE-MRA检出狭窄肾动脉数量比较 30例病例、61条肾动脉中,CE-MRA检出肾动脉狭窄者9例(30%),狭窄动脉11条,NCE-MRA检测出肾动脉狭窄患者10例(33.33%),狭窄动脉12条。以CE-MRA的结果作为参考标准,NCE-MRA检测肾动脉狭窄的灵敏度及特异度分别为：90.91%、96%,阳性预测值和阴性预测值分别为83.33%、97.96%,漏诊率、误诊率及准确率分别为：9.09%、4%和95.08%。进行2×2配对资料的关联性分析,认为两种检查方法在狭窄肾动脉数量的检测上存在关联性,且关联较密切(P0.05,r=0.841),进行配对资料x2检验,NCE-MRA与CE-MRA在狭窄动脉检出率上的差异无统计学意义。 5. NCE-MRA与CE-MRA对肾动脉狭窄程度的评估本研究将肾动脉狭窄程度分为4个级别：无狭窄、轻度狭窄、中度狭窄和重度狭窄。30例病例中,CE-MRA共检测出12处狭窄,其中轻度狭窄5处,中度狭窄5处,重度狭窄2处,NCE-MRA检出的12处狭窄中有8处与之符合,其诊断肾动脉狭窄程度的正确率为66.67%,另有4处不符,其中2处误诊、2处漏诊。CE-MRA诊断的2处轻度狭窄,在NCE-MRA上为无狭窄正常动脉；2处CE-MRA诊断的中度狭窄,在NCE-MRA上显示为重度狭窄。NCE-MRA诊断轻、中、重度肾动脉狭窄的灵敏度分别为60%、60%、100%,对轻度、中度、重度肾动脉狭窄的阳性预测值分别为60%、100%、50%。行Spearman等级相关分析,结果显示两种检查方法在评价肾动脉狭窄程度上显著相关(r=0.840,P0.01)。结论 1. NCE-MRA能够很好的描述肾动脉的形态,对远端分支的显示略优于CE-MRA,可作为肾动脉病变的筛查手段。 2.肾动脉NCE-MRA序列采用呼吸触发技术,无需屏气,患者更易配合,扫描成功率高,图像质量佳。 3. NCE-MRA评估肾动脉狭窄的准确率高,漏诊率低,其成像时间满足临床要求,可作为CE-MRA的有效替代检查方法。
[Abstract]:Objective To investigate the optimal scanning parameters of renal artery imaging with non - enhanced MRA ( NCE - MRA ) sequence .

2 . To evaluate the image quality of renal NCE - MRA ;

3 . Contrast - enhanced MRA ( CE - MRA ) was used to evaluate the ability of NCE - MRA to detect renal artery stenosis .

Materials and Methods From July 2012 to April 2014 , 30 patients ( 18 males and 12 females , age 14 - 81 years , mean age of 40 years ) underwent MR examination of renal artery .
( 2 ) showing the correlation between renal artery branching and vascular ability : ( 3 ) the correlation between the quality of renal artery imaging ( whether the diagnosis requirement is met ) ;
The sensitivity , specificity , positive predictive value , negative predictive value , accuracy rate , misdiagnosis rate and missed diagnosis rate of renal artery stenosis were calculated using CE - MRA as the standard .

Results

1 . NCE - MRA and CE - MRA sequences clearly show the number and type of renal arteries .

In 30 cases , 60 of renal arteries were clearly demonstrated by NCE - MRA , among them 59 main renal arteries , 1 accessory renal artery ( artery of secondary renal artery except main renal artery , without renal hilum , renal parenchyma artery alone ) , CE - MRA could clearly show 59 renal arteries , 58 main renal arteries and 1 accessory renal artery .
By Fisher ' s exact test , P0.05 , NCE - MRA and CE - MRA showed no statistical difference in the types of renal arteries .

2 . NCE - MRA and CE - MRA Sequence Analysis of Renal Artery Branch Vessels

In 30 cases 61 renal arteries , only 4 branches ( 6.56 % ) were shown in NCE - MRA , and 9 ( 14.75 % ) of branches in grade 2 showed that there were 12 branches ( 19.67 % ) .

3 . Comparison of NCE - MRA and CE - MRA renal artery image quality ( whether or not to meet diagnostic requirements )

The image quality of renal artery was 0 , 1 , 2 , 3 , 4 respectively . The renal arteries were 0 , 0 , 3 ( 4.92 % ) , 20 ( 32.79 % ) , 38 ( 62.29 % ) respectively .

4 . Comparison of NCE - MRA and CE - MRA in the Detection of Stenosis Renal Artery

According to the results of CE - MRA , the sensitivity and specificity of NCE - MRA in detecting renal artery stenosis were 90.91 % , 97.96 % and 95.08 % , respectively .

5 . Evaluation of the degree of renal artery stenosis by NCE - MRA and CE - MRA

In this study , the degree of renal artery stenosis was divided into 4 grades : no stenosis , mild stenosis , moderate stenosis and severe stenosis .
The sensitivity of NCE - MRA was 60 % , 60 % and 100 % respectively . The positive predictive values of mild , moderate and severe renal artery stenosis were 60 % , 100 % and 50 % , respectively . The results showed that the two methods were significantly correlated to evaluate the degree of renal artery stenosis ( r = 0.840 , P0.01 ) .

Conclusion

1 . NCE - MRA can describe the morphology of renal artery . The display of distal branches is slightly better than that of CE - MRA , which can be used as a screening instrument for renal artery disease .

2 . The NCE - MRA sequence of renal artery adopts respiratory triggering technique , does not need screen breath , the patient is more easily matched , the scanning success rate is high , and the image quality is good .

3 . NCE - MRA can evaluate the accuracy of renal artery stenosis , the rate of missed diagnosis is low , its imaging time meets the clinical requirement , and can be used as an effective alternative to CE - MRA .

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R692

【参考文献】