Peripheral arterial disease in a symptomatic diabetic population: prospective comparison of rapid unenhanced MR angiography (MRA) with contrast-enhanced MRA.
Peripheral arterial disease in a symptomatic diabetic population: prospective comparison of rapid unenhanced MR angiography (MRA) with contrast-enhanced MRA.
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DOI：
10.2214/ajr.10.6091
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发表时间：
2011-12
期刊：
影响因子：
--
通讯作者：
Edelman RR
中科院分区：
文献类型：
--
作者：
Hodnett PA;Ward EV;Davarpanah AH;Scanlon TG;Collins JD;Glielmi CB;Bi X;Koktzoglou I;Gupta N;Carr JC;Edelman RR
美国心脏病学会和美国心脏协会的联合指南支持使用对比增强磁共振血管造影（CEMRA）来诊断已知或疑似外周动脉疾病（PAD）患者的狭窄位置和程度。患有 PAD 的糖尿病患者慢性肾功能损害的患病率很高，并且需要高剂量的钆造影剂，使他们面临肾源性系统性纤维化的风险。我们研究的目的是评估静态间隔单次 (QISS) 非增强 MR 血管造影 (MRA) 快速技术与 CEMRA 相比对有症状的慢性 PAD 糖尿病患者诊断的准确性。这项前瞻性两中心研究对 25 名连续患有记录或疑似 PAD 症状的糖尿病患者进行了评估。两个中心使用相同的成像方案。图像由两名放射科医生独立分析。对患者进行了亚组分析，这些患者还接受了数字减影血管造影（DSA）评估，作为血运重建前标准护理方案的一部分。本研究分析了 775 个片段。在每个分部的基础上，两位评审员（评审员 1 和 2）的未增强 MRA 与参考 CEMRA 的诊断准确性平均值如下：敏感性，87.4% 和 92.1%；特异性分别为96.8%和96.0%；阳性预测值分别为90.8%和94.0%；阴性预测值分别为 95.5% 和 94.6%。在接受 DSA 的患者亚组中，将 DSA 总体结果与 QISS 未增强 MRA (κ = 0.68) 和 CEMRA (κ = 0.63) 进行比较，结果发现基本一致。两位读者之间的狭窄评分几乎完全一致，两种 MRA 技术的 Cohen kappa 值都大于 0.80。我们的研究结果表明，QISS 非增强 MRA 是 CEMRA 的准确非对比替代品，可用于显示有症状的 PAD 糖尿病患者的临床显着动脉疾病。
The joint guidelines of the American College of Cardiology and American Heart Association support the use of contrast-enhanced MR angiography (CEMRA) to diagnose the location and degree of stenosis in patients with known or suspected peripheral arterial disease (PAD). The high prevalence of chronic renal impairment in diabetic patients with PAD and the need for high doses of gadolinium-based contrast agents place them at risk for nephrogenic systemic fibrosis. The purpose of our study was to evaluate the accuracy of the rapid technique of quiescent-interval single-shot (QISS) unenhanced MR angiography (MRA) compared with CEMRA for the diagnosis in diabetic patients referred with symptomatic chronic PAD. This prospective two-center study evaluated 25 consecutive diabetic patients with documented or suspected symptomatic PAD. Both centers used identical imaging protocols. Images were independently analyzed by two radiologists. A subgroup analysis was performed of patients who were also assessed with digital subtraction angiography (DSA) as part of the standard-of-care protocol before revascularization. For this study, 775 segments were analyzed. On a per-segment basis, the mean values of the diagnostic accuracy of unenhanced MRA compared with reference CEMRA for two reviewers, reviewers 1 and 2, were as follows: sensitivity, 87.4% and 92.1%; specificity, 96.8% and 96.0%; positive predictive value, 90.8% and 94.0%; and negative predictive value, 95.5% and 94.6%. Substantial agreement was found when overall DSA results were compared with QISS unenhanced MRA (κ = 0.68) and CEMRA (κ = 0.63) in the subgroup of patients who also underwent DSA. There was almost perfect agreement between the two readers for stenosis scores, with Cohen’s kappa values being greater than 0.80 for both MRA techniques. The results of our study indicate that QISS unenhanced MRA is an accurate noncontrast alternative to CEMRA for showing clinically significant arterial disease in patients with diabetes with symptomatic PAD.