本文選題：腎動(dòng)脈狹窄　切入點(diǎn)：腎動(dòng)脈　出處：《昆明醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的1.探索非增強(qiáng)MRA (NCE-MRA)序列進(jìn)行腎動(dòng)脈成像的最佳掃描參數(shù)； 2.評(píng)價(jià)腎動(dòng)NCE-MRA的圖像質(zhì)量； 3.以對(duì)比增強(qiáng)MRA(CE-MRA)為參照,評(píng)估NCE-MRA檢測(cè)腎動(dòng)脈狹窄的能力。 材料和方法搜集我院2012年7月～2014年4月臨床診斷為高血壓、需行腎動(dòng)脈MR檢查的患者30例(男18例,女12例,年齡14-81歲,平均年齡40歲),排除MR檢查禁忌癥后,在同一MR設(shè)備上先后行腎動(dòng)且NCE-MRA及CE-MRA檢查。使用美國(guó)GE公司Signa1.5TMR.超導(dǎo)掃描儀、8通道TORSOPA體部線圈。擺好患者體位后,先行呼吸觸發(fā)3D反轉(zhuǎn)恢復(fù)穩(wěn)態(tài)自由進(jìn)動(dòng)序列,掃描范圍需包括雙側(cè)腎臟,軸位成像,成像時(shí)間約3.5-4.5min。再行快速擾相梯度回波CE-MRA序列,掃描范圍包括雙側(cè)腎臟及腹主動(dòng)脈,行3D冠狀位成像,注射釓造影劑后約14-20s,囑患者屏氣進(jìn)行腎臟血管3期圖像采集,每期用時(shí)約12s。所有原始數(shù)據(jù)采用AW4.4圖像處理軟件進(jìn)行重建和分析。分析NCE-MRA與CE-MRA在：①清晰顯示腎動(dòng)脈數(shù)量和種類方面有無(wú)統(tǒng)計(jì)學(xué)差異；②顯示腎動(dòng)脈分支血管能力的相關(guān)性：③腎動(dòng)脈成像質(zhì)量(是否滿足診斷要求)上的相關(guān)性；④診斷腎動(dòng)脈狹窄方面的相關(guān)性,以CE-MRA為標(biāo)準(zhǔn),計(jì)算NCE-MRA診斷腎動(dòng)脈狹窄的靈敏度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值、準(zhǔn)確率、誤診率及漏診率。 結(jié)果 1. NCE-MRA與CE-MRA序列清晰顯示腎動(dòng)脈的數(shù)量及種類 30例病例中,NCE-MRA可清晰顯示腎動(dòng)脈60條,其中59條主腎動(dòng)脈,1條副腎動(dòng)脈(副腎動(dòng)脈指除主腎動(dòng)脈外,不經(jīng)腎門(mén),單獨(dú)穿入腎實(shí)質(zhì)的動(dòng)脈),CE-MRA可清晰顯示腎動(dòng)脈59條,主腎動(dòng)脈58條,副腎動(dòng)脈1條。利用配對(duì)資料的x2檢驗(yàn),NCE-MRA與CE-MRA在清晰顯示腎動(dòng)脈數(shù)量上無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；經(jīng)Fisher精確檢驗(yàn),P0.05, NCE-MRA和CE-MRA在清晰顯示的腎動(dòng)脈種類方面亦無(wú)統(tǒng)計(jì)學(xué)差異。 2. NCE-MRA與CE-MRA序列對(duì)腎動(dòng)脈分支血管的顯示 30例病例61條腎動(dòng)脈中,NCE-MRA僅顯示主干者4條(6.56%),顯示到1級(jí)分支者9條(14.75%),顯示到2級(jí)分支的有12條(19.67%),顯示到3級(jí)分支者36條(59.02%); CE-MRA僅顯示腎動(dòng)脈主干的有4條(6.56%),顯示到1級(jí)分支者9條(14.75%),顯示到2級(jí)分支者14條(22.95%),顯示到3級(jí)分支的有34條(55.74%)。行Spearman相關(guān)分析,兩種檢查方法顯示腎動(dòng)脈分支血管的能力呈顯著相關(guān)(r=0.547,P0.01)。 3. NCE-MRA與CE-MRA腎動(dòng)脈圖像質(zhì)量(是否滿足診斷要求)比較 腎動(dòng)脈圖像質(zhì)量按照0(圖像質(zhì)量極差)-4(圖像質(zhì)量?jī)?yōu)秀)分計(jì)分。以腎動(dòng)脈為單位,NCE-MRA圖像質(zhì)量獲得0、1、2、3、4分的腎動(dòng)脈分別為0條、0條、3條(4.92%)、20條(32.79%)、38條(62.29%), CE-MRA則分別為0條、2條(3.28%)、2條(3.28%)、21條(34.42%)、36條(59.02%), NCE-MRA圖像全部滿足診斷要求,CE-MRA有1例患者的2條腎動(dòng)脈偽影重(得1分),不能作出診斷。經(jīng)Spearman等級(jí)相關(guān)分析,在腎動(dòng)脈的成像質(zhì)量方面,NCE-MRA與CE-MRA一致性好(r=0.868,p0.01)。 4. NCE-MRA與CE-MRA檢出狹窄腎動(dòng)脈數(shù)量比較 30例病例、61條腎動(dòng)脈中,CE-MRA檢出腎動(dòng)脈狹窄者9例(30%),狹窄動(dòng)脈11條,NCE-MRA檢測(cè)出腎動(dòng)脈狹窄患者10例(33.33%),狹窄動(dòng)脈12條。以CE-MRA的結(jié)果作為參考標(biāo)準(zhǔn),NCE-MRA檢測(cè)腎動(dòng)脈狹窄的靈敏度及特異度分別為：90.91%、96%,陽(yáng)性預(yù)測(cè)值和陰性預(yù)測(cè)值分別為83.33%、97.96%,漏診率、誤診率及準(zhǔn)確率分別為：9.09%、4%和95.08%。進(jìn)行2×2配對(duì)資料的關(guān)聯(lián)性分析,認(rèn)為兩種檢查方法在狹窄腎動(dòng)脈數(shù)量的檢測(cè)上存在關(guān)聯(lián)性,且關(guān)聯(lián)較密切(P0.05,r=0.841),進(jìn)行配對(duì)資料x(chóng)2檢驗(yàn),NCE-MRA與CE-MRA在狹窄動(dòng)脈檢出率上的差異無(wú)統(tǒng)計(jì)學(xué)意義。 5. NCE-MRA與CE-MRA對(duì)腎動(dòng)脈狹窄程度的評(píng)估 本研究將腎動(dòng)脈狹窄程度分為4個(gè)級(jí)別：無(wú)狹窄、輕度狹窄、中度狹窄和重度狹窄。30例病例中,CE-MRA共檢測(cè)出12處狹窄,其中輕度狹窄5處,中度狹窄5處,重度狹窄2處,NCE-MRA檢出的12處狹窄中有8處與之符合,其診斷腎動(dòng)脈狹窄程度的正確率為66.67%,另有4處不符,其中2處誤診、2處漏診。CE-MRA診斷的2處輕度狹窄,在NCE-MRA上為無(wú)狹窄正常動(dòng)脈；2處CE-MRA診斷的中度狹窄,在NCE-MRA上顯示為重度狹窄。NCE-MRA診斷輕、中、重度腎動(dòng)脈狹窄的靈敏度分別為60%、60%、100%,對(duì)輕度、中度、重度腎動(dòng)脈狹窄的陽(yáng)性預(yù)測(cè)值分別為60%、100%、50%。行Spearman等級(jí)相關(guān)分析,結(jié)果顯示兩種檢查方法在評(píng)價(jià)腎動(dòng)脈狹窄程度上顯著相關(guān)(r=0.840,P0.01)。 結(jié)論 1. NCE-MRA能夠很好的描述腎動(dòng)脈的形態(tài),對(duì)遠(yuǎn)端分支的顯示略優(yōu)于CE-MRA,可作為腎動(dòng)脈病變的篩查手段。 2.腎動(dòng)脈NCE-MRA序列采用呼吸觸發(fā)技術(shù),無(wú)需屏氣,患者更易配合,掃描成功率高,圖像質(zhì)量佳。 3. NCE-MRA評(píng)估腎動(dòng)脈狹窄的準(zhǔn)確率高,漏診率低,其成像時(shí)間滿足臨床要求,可作為CE-MRA的有效替代檢查方法。
[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 .

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R692

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