目的 本研究旨在探讨基于延迟进动定制激发(delay alternating with nutation for tailored excitation,DANTE)和可变翻转角快速自旋回波(sampling perfection with application-optimized contrasts by using different flip angle evolutions,SPACE)的多序列磁共振血管壁成像(magnetic resonance vessel wall imaging,MR-VWI)对下肢动脉病变(lower extremity arterial disease,LEAD)的诊断价值.材料与方法 回顾性分析了57例LEAD患者和26例无LEAD患者的病例及影像资料.所有患者均在3.0 T MRI设备上接受了T2快速自旋回波序列(turbo spin echo,TSE)、T1w DANTE-SPACE、对比增强(contrast enhancement,CE)T1w DANTE-SPACE和CE磁共振血管造影(magnetic resonance angiography,MRA)MR-VWI扫描.两名放射科医师在双盲条件下分别测量了T1w DANTE-SPACE和T2w TSE序列图像相应位置的管腔面积(lumen area,LA)、管壁面积(vessel wall area,VWA)、平均管壁厚度(average vessel wall,AVW)和最大管壁厚度(maximum vessel wall,MVW)等形态学指标.每位医师在3周间隔后对相同指标进行了重复测量.采用组内相关系数(intra-class correlation coefficients,ICC)和Bland-Altman方法评估了两种扫描技术以及不同组别之间的T1w DANTE-SPACE形态学测量指标的观察者一致性和可重复性.使用受试者工作特征(receiver operating characteristic,ROC)曲线评估了准确性.结果 T1w DANTE-SPACE与T2w TSE成像技术的信噪比(signal-to-noise ratio,SNR)和对比度比(contrast-to-noise ratio,CNR)差异有统计学意义(P<0.05),两名观察者对形态学测量指标的ICC值在0.85～0.99之间.在不同组别中,T1w DANTE-SPACE形态学测量指标的两次测量ICC值为0.90～0.99.Bland-Altman分析显示,观察者间和两次测量间的大部分形态学测量指标均在95％的一致性限度内.T1w DANTE-SPACE技术在LEAD组不同血管节段的形态学指标ROC曲线下面积(area under the curve,AUC)分别为0.904[95％置信区间(confidence interval,CI):0.825～0.983]和0.905(95％CI:0.835～0.976).当腘小腿动脉段的血管壁厚度为1.00 mm,LA为10.88 mm时,LEAD的敏感度分别为79.2％和85.4％,特异度分别为96.2％和92.3％,阳性预测值分别为97.4％和95.3％,阴性预测值分别为71.4％和77.4％.结论 多序列MR-VWI在评估LEAD斑块形态学指标方面表现出良好的重复性和高准确性,支持其在LEAD的MRI检查中的应用.
Diagnosis of lower extremity arterial disease based on multi-sequence magnetic resonance vessel wall imaging
Objective:To investigate the clinical utility of delay alternating with nutation for tailored excitation (DANTE) and sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE) in multi-sequence magnetic resonance vessel wall imaging (MR-VWI) for diagnosing lower extremity arterial disease (LEAD). Materials and Methods:The case and imaging data from 57 LEAD patients and 26 without LEAD patients were retrospectively included. All patients underwent T2-weighted turbo spin echo (T2w-TSE),T1-weighted DANTE-SPACE,contrast-enhanced T1-weighted DANTE-SPACE,and contrast-enhanced magnetic resonance angiography (CE-MRA) MR-VWI scans on 3.0 T MRI equipment. Lumen area (LA),vessel wall area (VWA),and average vessel wall thickness (AVW) were measured by two radiologists in a double-blind procedure. The intra-class correlation coefficient (ICC) and Bland-Altman method were used to assess inter-observer agreement and agreement between different scanning techniques. Receiver operating characteristic (ROC) curves were used to evaluate accuracy. Results:Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values were significantly different between T1w DANTE-SPACE and 2D TSE imaging techniques (P<0.05). ICC values for morphological measurements ranged from 0.85 to 0.99 between two observers and from 0.90 to 0.99 for repeated measurements. Bland-Altman analysis showed good agreement between observers and measurements. The T1w DANTE-SPACE technique was applied to the morphological measurement index ROC of different vascular segments in the LEAD group,resulting in area under the curve (AUC) values of 0.904[95％ confidence interval (CI):0.825-0.983]and 0.905 (95％ CI:0.835-0.976),respectively. When the vessel wall thickness of the popliteal artery segment was 1.00 mm and the lumen area (LA) was 10.88 mm,serving as the critical values,the sensitivity for LEAD was 79.2％ and 85.4％,the specificity was 96.2％ and 92.3％,the positive predictive value was 97.4％ and 95.3％,and the negative predictive value was 71.4％ and 77.4％,respectively. Conclusions:Multi-sequence MR-VWI demonstrates good repeatability and high accuracy in evaluating morphological indicators of LEAD plaques,supporting its application in MRI examinations of LEAD.
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