非增强速度选择性磁共振血管成像（VS-MRA）：在外周动脉疾病患者中的初步临床评估。
Unenhanced Velocity-Selective MR Angiography (VS-MRA): Initial Clinical Evaluation in Patients With Peripheral Artery Disease.
机构信息
Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, South Korea.
Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Maryland, USA.
出版信息
J Magn Reson Imaging. 2019 Mar;49(3):744-751. doi: 10.1002/jmri.26268. Epub 2018 Sep 13.
BACKGROUND
Safe and accurate imaging of the peripheral arterial system is important for diagnosis and treatment planning of patients with peripheral artery disease (PAD).
PURPOSE
To evaluate image quality and diagnostic performance of unenhanced magnetic resonance angiography (MRA) based on velocity-selective (VS) magnetization preparation (termed VS-MRA).
STUDY TYPE
Prospective.
POPULATION
Thirty-one symptomatic PAD patients underwent VS-MRA. Twenty-four of them underwent clinical digital subtraction angiography (DSA) examination, 18.8 ± 5.2 days after the MR scans.
FIELD STRENGTH/SEQUENCE: 1.5T MRI that included VS-MRA (homemade research sequence) and phase-contrast flow imaging (clinical sequence).
ASSESSMENT
Image quality (0: nondiagnostic, 3: excellent) and stenosis severity (0: normal, 3: occlusion) of VS-MRA images were assessed independently by three reviewers. Arterial signal-to-noise-ratio (SNR) and artery-to-muscle contrast-to-noise ratio (CNR) were calculated.
STATISTICAL TESTS
The sensitivity and specificity of VS-MRA were calculated for the detection of significant stenosis (>50%) with DSA as the reference standard. Interobserver agreement among the three reviewers was evaluated by using Cohen κ-statistics.
RESULTS
The image quality score of VS-MRA was 2.7 ± 0.5 for Reader 1, 2.8 ± 0.5 for Reader 2, and 2.8 ± 0.4 for Reader 3; SNR and CNR were 37.8 ± 12.5 and 30.5 ± 11.8, respectively. Segment-based analysis revealed that VS-MRA had sensitivities of 85.3%, 74.5%, and 78.4%, respectively, for the three reviewers, and specificities of 93.5%, 96.8%, and 95.2%. The interobserver agreement for the stenosis grading was good, as demonstrated by Cohen κ values of 0.76 (Reader 1 vs. Reader 2), 0.82 (Reader 1 vs. Reader 3), and 0.79 (Reader 2 vs. Reader 3).
DATA CONCLUSION
Unenhanced VS-MRA allows clear depiction of the peripheral arteries and accurate stenosis grading, as evidenced by high image quality scores and strong agreement with DSA.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:744-751.
背景
安全、准确的外周动脉系统成像对于外周动脉疾病（PAD）患者的诊断和治疗计划非常重要。
目的
评估基于速度选择（VS）磁化准备（称为 VS-MRA）的非增强磁共振血管造影（MRA）的图像质量和诊断性能。
研究类型
前瞻性。
人群
31 名有症状的 PAD 患者接受了 VS-MRA 检查。其中 24 名患者在 MRI 扫描后 18.8±5.2 天接受了临床数字减影血管造影（DSA）检查。
磁场强度/序列：1.5T MRI 包括 VS-MRA（自制研究序列）和相位对比血流成像（临床序列）。
评估
由三位观察者独立评估 VS-MRA 图像的质量（0：无法诊断，3：优秀）和狭窄严重程度（0：正常，3：闭塞）。计算动脉信噪比（SNR）和动脉-肌肉对比噪声比（CNR）。
统计检验
以 DSA 为参考标准，计算 VS-MRA 检测显著狭窄（>50%）的灵敏度和特异性。通过 Cohen κ 统计评估三位观察者之间的观察者间一致性。
结果
VS-MRA 的图像质量评分分别为 Reader 1 的 2.7±0.5、Reader 2 的 2.8±0.5 和 Reader 3 的 2.8±0.4；SNR 和 CNR 分别为 37.8±12.5 和 30.5±11.8。基于节段的分析显示，三位观察者的 VS-MRA 分别具有 85.3%、74.5%和 78.4%的灵敏度，93.5%、96.8%和 95.2%的特异性。观察者间狭窄分级的一致性良好，Cohen κ 值分别为 0.76（Reader 1 与 Reader 2）、0.82（Reader 1 与 Reader 3）和 0.79（Reader 2 与 Reader 3）。
数据结论
未增强的 VS-MRA 可以清晰显示外周动脉并准确分级狭窄，表现为高图像质量评分和与 DSA 的高度一致性。
证据水平
2 技术功效：第 2 阶段 J. Magn. Reson. Imaging 2019;49:744-751.
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