基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列在评估移植肾血管解剖和并发症方面的研究

发布时间：2018-06-18 13:07

本文选题：移植肾 + 血管解剖　；参考：《华中科技大学》2014年博士论文

【摘要】：第一部分：基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)在评估移植肾血管解剖方面的研究目的：评估基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)在显示移植肾血管解剖方面的价值,并和彩色多普勒超声(CDUS)及术中记录结果进行对照。材料和方法：应用GE公司1.5T HD MR扫描仪对75名行肾移植手术后临床需要排除血管并发症的患者进行彩色多普勒超声扫描及非对比剂增强磁共振血管成像扫描,所有患者检查前均签署知情同意书。由两名放射科专家对SLEEK显示移植肾血管解剖结构进行评估,并将SLEEK结果与彩色多普勒超声及术中记录结果进行对照。结果：总共75名肾移植患者,所有患者均成功进行了SLEEK扫描及彩色多普勒超声扫描。有三名患者移植了两个肾脏,总共有78例移植肾进行了图像评估,所有患者的图像质量都是可以接受的。图像质量评分为优秀的占85%(66/78),良好的占10%(8/78),一般的占5%(4/78)。在检查移植肾血管吻合方式方面,SLEEK检查结果与术中记录完全吻合,发现72个肾脏被移植在右侧髂窝,6个肾脏被移植在左侧髂窝。移植肾动脉与髂外动脉端侧吻合的有43例,移植肾动脉与髂内动脉端端吻合的有35例,所有78例移植肾静脉均与髂外静脉端侧吻合。这一结果与彩色多普勒超声对比没有明显统计学意义(P0.05)。SLEEK在检出副肾动脉方面明显优于彩色多普勒超声(P0.05),根据手术记录75名患者的78个移植肾中有9个移植肾有副肾动脉,SLEEK发现了其中的8例,超声只发现了2例。结论：基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)无创、无辐射在显示移植肾血管解剖方面显示出了很好的应用价值,在显示移植肾的位置和血管吻合方法方面与彩色多普勒超声没有显著统计学差异,在显示副肾动脉方面优于彩色多普勒超声。对临床医生评估移植肾的术后状态提供了新的客观依据。第二部分：基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)在评估移植肾血管并发症方面的研究目的：评估基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)在显示移植肾血管并发症方面的价值,并和彩色多普勒超声(CDUS)、 DSA及手术结果进行对照。材料和方法：应用GE公司1.5T HD MR扫描仪对23名行肾移植手术后经超声检查后临床高度怀疑血管并发症的患者行非对比剂增强磁共振血管成像扫描扫描,所有患者检查前均签署知情同意书。随后其中有15名患者行DSA检查(6人行球囊扩张及支架植入术,7人行球囊扩张术,2人仅行血管造影),8名患者进行了手术。由两名放射科专家对SLEEK显示移植肾血管并发症进行评估,并将SLEEK结果与彩色多普勒超声、DSA及手术结果进行对照。结果：23名行肾移植手术后经超声检查后临床高度怀疑血管并发症的患者,所有患者均成功进行了SLEEK扫描。经DSA及手术确定的23名并发症患者中移植肾动脉狭窄有11例,移植肾动脉闭塞有3例,移植肾动脉扭曲有3例,移植肾静脉狭窄有2例,动静脉瘘有2例,假性动脉瘤有1例,肌纤维发育不良有1例。SLEEK检查出了其中所有的23例并发症,彩色多普勒超声检查出了其中19例,两者没有明显的统计学差异(P0.05)。结论：基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)无创、无辐射在显示移植肾血管并发症方面显示出了很好的应用价值,其结果与彩色多普勒超声并无明显统计学差异。第三部分：基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)对移植肾动脉狭窄的评估：与DSA相对照目的：以数字减影血管造影(DSA)为金标准,评估基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)在显示移植肾狭窄方面的价值。材料和方法：本研究收集行SLEEK扫描并行DSA进一步确诊的肾移植患者11例,所有患者检查前均签署知情同意书。应用GE公司1.5T HD MR扫描仪对11名肾移植患者行非对比剂增强磁共振血管成像扫描扫描,随后11名患者行DSA检查。由两名放射科医生对SLEEK显示移植肾动脉狭窄程度进行评估,并将SLEEK结果与DSA结果进行对照。结果：11名经DSA验证的的肾移植患者均成功进行了SLEEK扫描。经DSA确定的1度狭窄患者有4例,2度狭窄有6例,3度狭窄有1例。除了1例轻度狭窄患者被SLEEK过高估计狭窄程度外,其余均与DSA显示的一致,SLEEK对临床上显著狭窄(狭窄程度50%)的阳性预测值为87.5%,阴性预测值为100%,灵敏度为100%,特异度为75%,准确度为：90.9%。SLEEK与DSA在评估移植肾动脉狭窄程度方面的有着很好的相关性(r=0.96；P0.05)。相对于DSA, SLEEK会稍微过高估计移植肾动脉狭窄的程度,但是这个差异没有显著统计学意义(Wilcoxon符号秩检验,P=0.57)。Bland-Altman plot显示以DSA为金标准SLEEK产生的误差很低(平均误差,3.2%±7.3%)。结论：基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)无创、无辐射,在评估移植肾动脉狭窄方面与DSA有着很好的一致性。SLEEK可以成为一种临床上评估移植肾动脉狭窄的方法。第四部分：肾移植患者肾动脉SLEEK扫描中BSP TI的参数优化目的：评估基于多翻转脉冲空间标记技术的非对比剂增强磁共振血管成像序列(SLEEK)应用在移植肾动脉方面时BSP TI的参数优化。材料和方法：对20名行肾移植的健康志愿者,应用GE公司1.5T HD MR扫描仪分别进行血液抑制反转时间(BSP TI)为500、800、1100、1400ms扫描,比较不同BSPTI下移植肾动脉主干、分支与肾实质的相对信号强度。结果：20名志愿者均成功实现了非对比剂移植肾动脉血管成像。BSP TI由500～1400ms,移植肾动脉远端分支的信号强度逐渐增强。在BSP TI=800ms或1100ms时,移植肾动脉与移植肾实质之间的相对信号强度最高。结论：在血流正常情况下BSP TI为800ms或1100ms时成像效果较好。
[Abstract]:Part one: a study of the vascular anatomy of renal allograft based on the noncontrast enhanced magnetic resonance angiography sequence (SLEEK) based on the multi flipping pulse space labeling technique
Objective: To evaluate the value of non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on multi reversal pulse space labeling technique in displaying the vascular anatomy of the transplanted kidney, and to compare with the results of color Doppler ultrasound (CDUS) and intraoperative records.
Materials and methods: color Doppler ultrasound scan and non contrast enhanced MRI scan were performed on 75 patients who were required to exclude vascular complications after renal transplantation by GE's 1.5T HD MR scanner. All patients signed informed consent before the examination. Two radiologists showed the transplant kidney to SLEEK. The vascular anatomy was assessed, and the results of SLEEK were compared with the results of color Doppler ultrasound and intraoperative recording.
Results: a total of 75 renal transplantation patients, all patients were successfully scanned with SLEEK and color Doppler ultrasound. Three patients had two kidneys. A total of 78 transplanted kidneys were evaluated. All the patients were acceptable. The image quality score was 85% (66/78), and the good accounted for 10%. 8/78) generally accounted for 5% (4/78). The results of SLEEK examination were fully anastomosed with the intraoperative records in examining the anastomosis of renal allograft. 72 kidneys were transplanted in the right iliac fossa and 6 kidneys were transplanted in the left iliac fossa. 43 cases were anastomosed to the end to side of the external iliac artery and 35 cases of the transplanted renal artery and the end-end of the internal iliac artery were anastomosed. All 78 cases of renal vein graft were anastomosed to the end to side of the external iliac vein. The results were not statistically significant compared with color Doppler ultrasound (P0.05).SLEEK was obviously superior to color Doppler ultrasound (P0.05) in the detection of the accessory renal artery, and 9 of the 78 transplanted kidneys had the pararenal artery in the 78 transplant kidneys. SLEEK 8 of them were present, and only 2 cases were found by ultrasound.
Conclusion: the non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on the multi reversal pulse space labeling technique is noninvasive. No radiation is of great value in displaying the vascular anatomy of the transplanted kidney. There is no significant difference between the color Doppler ultrasound and the location of the transplanted kidney and the method of vascular anastomosis. It shows that the accessory renal artery is superior to color Doppler ultrasound. It provides a new objective basis for clinicians to evaluate the postoperative state of transplanted kidney.
The second part: a study of non contrast enhanced magnetic resonance angiography (SLEEK) based on multi reversal pulse space labeling technique in assessing the complications of renal allograft
Objective: To evaluate the value of non contrast enhanced magnetic resonance angiography (SLEEK) based on multi reversal pulse space labeling technique in displaying renal vascular complications and to compare with color Doppler ultrasound (CDUS), DSA and surgical results.
Materials and methods: non contrast enhanced MRI scans were performed in 23 patients with highly suspected vascular complications after ultrasound examination with GE's 1.5T HD MR scanner. All patients signed informed consent before examination. 15 of them were followed by DSA examination (6 patients were treated with balloon dilatation. And stent implantation, 7 patients underwent balloon dilatation, 2 patients underwent only angiography, and 8 patients underwent surgery. Two radiologist experts evaluated the renal vascular complications of SLEEK, and compared the results of SLEEK with color Doppler ultrasound, DSA and surgical results.
Results: 23 patients with highly suspected vascular complications after renal transplantation were successfully scanned by SLEEK. There were 11 cases of renal graft stenosis in 23 patients with DSA and surgery, 3 cases of transplant renal artery occlusion, 3 transplanted renal artery distortion and 2 renal vein graft stenosis. There were 2 cases of arteriovenous fistula, 1 cases of pseudoaneurysm, 1 cases of myfibrous dysplasia with.SLEEK, all of which were detected in 23 of them, and 19 of them were detected by color Doppler ultrasound. There was no significant difference between the two cases (P0.05).
Conclusion: non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on multi reversal pulse space labeling technique is noninvasive, and no radiation has a good application value in showing the complications of renal transplantation, and there is no significant difference between the results and color Doppler ultrasound.
Third part: evaluation of renal allograft stenosis by non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on multi flip pulse space labeling technique: relative to DSA
Objective: To evaluate the value of non contrast enhanced magnetic resonance angiography (SLEEK) based on multi reversal pulse space labeling (DSA) as the gold standard in the display of renal graft stenosis.
Materials and methods: This study collected 11 patients with SLEEK scan and DSA further confirmed renal transplantation. All patients signed informed consent before examination. The GE company 1.5T HD MR scanner was used to scan 11 renal transplant patients with non contrast enhanced MRI scan, and 11 patients were followed by DSA examination. Two patients were radiating by DSA. They evaluated the degree of renal artery stenosis by SLEEK and compared the results of SLEEK with that of DSA.
Results: 11 DSA confirmed renal transplant patients successfully performed SLEEK scan. There were 4 cases of 1 degree stenosis confirmed by DSA, 6 cases with 2 degree stenosis and 1 cases with 3 degree stenosis. Except for 1 cases of mild stenosis, the degree of stenosis was higher than that of DSA, and SLEEK was a positive clinical stenosis (50% in the degree of stenosis). The predictive value was 87.5%, the negative predictive value was 100%, the sensitivity was 100%, the specificity was 75%, and the accuracy was: 90.9%.SLEEK and DSA had a good correlation (r=0.96; P0.05) in assessing the degree of renal artery stenosis (r=0.96; P0.05). Relative to DSA, the degree of renal artery stenosis was too high to be estimated, but there was no significant difference in this difference. The significance of the study (Wilcoxon signed rank test, P=0.57).Bland-Altman plot shows that the error produced by DSA is the gold standard, and the error produced by SLEEK is very low (the average error is 3.2% + 7.3%).
Conclusion: the non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on the multi reversal pulse space labeling technique is noninvasive, without radiation, and has a good consistency with DSA in assessing the renal artery stenosis..SLEEK can be a clinical evaluation of renal allograft stenosis.
The fourth part: parameter optimization of BSP TI in renal artery SLEEK scanning of renal transplant patients.
Objective: To evaluate the parameters optimization of BSP TI using non contrast enhanced magnetic resonance angiography sequence (SLEEK) based on multi reversal pulse space labeling technique in the application of renal allograft artery.
Materials and methods: in 20 healthy volunteers who underwent renal transplantation, the GE 1.5T HD MR scanner was used to perform a 50080011001400ms scan (BSP TI), respectively, to compare the relative signal intensity of the renal artery and the renal parenchyma under the different BSPTI.
Results: all the 20 volunteers successfully realized the.BSP TI from 500 to 1400ms, and the signal intensity of the distal branch of the transplanted renal artery was gradually enhanced. The relative signal intensity between the transplanted renal artery and the renal parenchyma was the highest at BSP TI=800ms or 1100ms.
Conclusion: when the blood flow is normal, the imaging effect of BSP TI is 800ms or 1100ms.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.2;R699.2

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