Zhang Long Jiang, Wu Xinsheng, Yang Gui Fen, Tang Chun Xiang, Luo Song, Zhou Chang Sheng, Ji Xue Man, Lu Guang Ming
Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, PR China.
Acta Radiol. 2013 Dec;54(10):1125-31. doi: 10.1177/0284185113490152. Epub 2013 Jun 21.
Renal vein thrombosis is not uncommon, however, there have been few reports on the diagnostic accuracy of three-dimensional contrast-enhanced magnetic resonance venography (3D-CE-MRV) in the detection of renal vein thrombosis (RVT).
To evaluate the value of 3D-CE-MRV for detecting RVT with multidetector computed tomography (CT) venography as reference standard.
Thirty-two patients with nephrotic syndrome underwent renal CT venography and gradient echo pulse sequence (FLASH 3D) 3D-CE-MRV in a clinical 3-T whole-body MR scanner for suspected RVT with time interval of 0-5 days. RVT was recorded on a per-patient and per-vessel (left renal vein, right renal vein, and inferior vena cava) basis. The diagnostic accuracy of 3D-CE-MRV for detection of RVT was calculated with CT venography as reference standard. Inter-reader agreement for RVT detection was evaluated using Kappa statistics.
Of 32 patients, CT venography detected 22 vessels with thrombosis in 17 patients, including five in right renal veins, 14 in left renal veins, and three in inferior vena cava, while 15 patients had no RVT. 3D-CE-MRV detected 21 vessels (21/96, 21.9%) with thrombosis in 16 patients (6/32, 50%), including five in right renal veins, 13 in left renal veins, and three in inferior vena cava, while 16 patients (16/32, 50%) had no RVT. With CT venography as reference standard, the sensitivities and specificities of 3D-CE-MRV for RVT detection were 94.1%, 100%; 95.5%, 100% on a per-patient and a per-vessel basis, respectively. Excellent inter-reader agreement (Kappa value = 0.969, P < 0.001) was observed for RVT detection.
3D-CE-MRV has a high diagnostic accuracy in the detection of RVT, which is optimal alternative imaging modality in the detection of RVT.
肾静脉血栓形成并不罕见，然而，关于三维对比增强磁共振静脉造影（3D-CE-MRV）检测肾静脉血栓形成（RVT）的诊断准确性的报道较少。
以多排螺旋计算机断层扫描（CT）静脉造影为参考标准，评估3D-CE-MRV检测RVT的价值。
32例肾病综合征患者因疑似RVT在临床3-T全身磁共振扫描仪上接受了肾CT静脉造影和梯度回波脉冲序列（FLASH 3D）3D-CE-MRV检查，时间间隔为0 - 5天。RVT按每位患者和每条血管（左肾静脉、右肾静脉和下腔静脉）记录。以CT静脉造影为参考标准，计算3D-CE-MRV检测RVT的诊断准确性。使用Kappa统计量评估阅片者间对RVT检测的一致性。
32例患者中，CT静脉造影在17例患者中检测到22条血管有血栓形成，其中右肾静脉5条，左肾静脉14条，下腔静脉3条，而15例患者无RVT。3D-CE-MRV在16例患者（6/32，50%）中检测到21条血管（21/96，21.9%）有血栓形成，其中右肾静脉5条，左肾静脉13条，下腔静脉3条，而16例患者（16/32，50%）无RVT。以CT静脉造影为参考标准，3D-CE-MRV检测RVT的敏感度和特异度在每位患者和每条血管基础上分别为94.1%、100%；95.5%、100%。在RVT检测方面观察到阅片者间具有极好的一致性（Kappa值 = 0.969，P < 0.001）。
3D-CE-MRV在检测RVT方面具有较高的诊断准确性，是检测RVT的最佳替代成像方式。
