Diagnosing Recurrent DVT of the Leg by Two Different Non-Contrast-Enhanced Magnetic Resonance Direct Thrombus Imaging Techniques: A Pilot Study.
Diagnosing Recurrent DVT of the Leg by Two Different Non-Contrast-Enhanced Magnetic Resonance Direct Thrombus Imaging Techniques: A Pilot Study.
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DOI：
10.1055/s-0039-1678683
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发表时间：
2019-01-01
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影响因子：
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通讯作者：
Kroft, Lucia J M
中科院分区：
文献类型：
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作者：
Dronkers, Charlotte E A;Klok, Frederikus A;Kroft, Lucia J M
引言磁共振直接血栓成像（MRDTI）是一种很有前途的技术，以提高诊断管理的患者怀疑同侧复发性深静脉血栓形成（DVT）的直接可视化血栓。另一种磁共振成像（MRI）技术，T1加权快速自旋回波频谱衰减反转恢复（TSE-SPAIR），也有可能直接对血栓进行高空间分辨率成像。本初步研究的主要目的是调查在疑似复发性DVT患者中进行的MRDTI序列中添加TSE-SPAIR序列是否可以增加专家MRDTI阅片者的诊断信心。方法对15例疑似急性复发DVT患者进行回顾性分析。TSE-SPAIR序列在MRDTI扫描后直接扫描，但不用于指导临床决策，两次扫描均由三名独立的MRDTI读片专家分别事后判定两次。诊断置信度采用4分制Likert量表评分：（1）差（不可能确诊），（2）一般（可能评价主要发现），（3）好（可能确诊），（4）优（可能准确诊断）。结果当在MRDTI序列上添加TSE-SPAIR序列时，专家阅片者的诊断信心从“良好”（中位数，3.0;四分位距[IQR]，2.66-3.0）增加到“极好”（中位数，3.67; IQR 3.33-3.67; p =0.001）。在初始阅读后5个月，以相反顺序对扫描进行评价，结果相似。两种扫描技术对近端DVT的诊断准确性良好。结论在疑似同侧复发DVT的病例中，增加TSE-SPAIR序列有助于提高诊断的信心。
Introduction Magnetic resonance direct thrombus imaging (MRDTI) is a promising technique to improve the diagnostic management of patients with a suspected ipsilateral recurrent deep vein thrombosis (DVT) by direct visualization of a thrombus. Another magnetic resonance imaging (MRI) technique, T1-weighted turbo spin-echo spectral attenuated inversion recovery (TSE-SPAIR), has the potential to image a thrombus directly with a high spatial resolution as well. The main aim of this pilot study was to investigate if adding the TSE-SPAIR sequence to an MRDTI sequence performed in patients with suspected recurrent DVT may increase the diagnostic confidence of expert MRDTI readers. Methods Fifteen patients with suspected acute recurrent DVT were included in this study. The TSE-SPAIR sequence was scanned directly after the MRDTI scan but not used to guide clinical decision making, and both scans were adjudicated post hoc two times separately by three independent expert MRDTI readers. Diagnostic confidence was scored on a 4-point Likert scale: (1) poor (definite diagnosis impossible), (2) fair (evaluation of major findings possible), (3) good (definite diagnosis possible), and (4) excellent (exact diagnosis possible). Results The diagnostic confidence of expert readers increased when adding the TSE-SPAIR sequence on top of the MRDTI sequence from "good" (median, 3.0; interquartile range [IQR], 2.66-3.0) to "excellent" (median, 3.67; IQR 3.33-3.67; p =0.001). Evaluation of the scans in the reversed order 5 months after initial reading showed similar results. Diagnostic accuracy for proximal DVT of both scan techniques was good. Conclusion The extra TSE-SPAIR sequence may help increase diagnostic confidence of radiologists in cases of uncertain diagnosis in patients with suspected ipsilateral recurrent DVT.