Mao Huan, Guan Xiuhong, Peng Kewen, Cai Yanjun, Yang Jing, He Xueping, Chen Hanwei, Zhang Xiaoyong, Bi Xiaoming, Liu Xin, Li Debiao, Fan Zhaoyang, Deng Zhixian, Xie Guoxi
Department of Biomedical Engineering, The Sixth Affiliated Hospital, School of Basic Sciences, Guangzhou Medical University, Guangzhou, China.
Department of Radiology, Nanshan People's Hospital, Shenzhen, China.
Quant Imaging Med Surg. 2021 Jan;11(1):276-289. doi: 10.21037/qims-19-761.
Black-blood thrombus imaging (BTI) has shown to be advantageous for the diagnosis of deep vein thrombosis (DVT). However, previous techniques using fast spin echo have a high specific absorption rate. As DANTE (delay alternating with nutation for tailored excitation) black-blood preparation can suppress blood flows over a broad range of velocities, we hypothesized that a DANTE black-blood preparation combined with a fast low-angle shot (FLASH) gradient-echo readout-DANTE-FLASH could be used to diagnose DVT.
Eleven healthy volunteers and 30 suspected DVT patients were recruited to undergo DANTE-FLASH and magnetic resonance direct thrombus imaging (MRDTI). The suspected DVT patients were also examined by ultrasound (US). For the segment level, a total of 1,066 venous vessel segments were analyzed. Using US and MRDTI as the references, the sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV), and accuracy (ACC) of DANTE-FLASH were calculated. To quantitatively compare image quality between DANTE-FLASH and MRDTI, image signal-to-noise ratio (SNR), apparent contrast-to-noise ratio (CNR) between muscle and the venous lumen, and the apparent CNR between the thrombus and venous lumen were measured. Additionally, diagnostic confidence, image quality, and clot burden were also evaluated.
Using the consensus results of US and MRDTI as a standard reference, the diagnostic SE, SP, PPV, NPV, and ACC of DANTE-FLASH for the 2 readers were 97.0% and 93.2%, 99.0% and 98.2%, 93.4% and 87.9%, 99.6% and 99.0%, and 98.8% and 97.6%, respectively. According to the image quantitative analysis results, DANTE-FLASH demonstrated higher image SNR and CNR than MRDTI. The image quality and diagnostic confidence scores of DANTE-FLASH were higher than MRDTI (3.66±0.44 3.52±0.52, P<0.001, and 3.84±0.36 3.76±0.41, P<0.001). There was excellent agreement between DANTE-FLASH and MRDTI on clot burden evaluation.
DANTE-FLASH provided better image quality than MRDTI and accurately detected thrombi. It may, therefore, serve as a safe and convenient alternative for the diagnosis of DVT.
黑血血栓成像（BTI）已被证明在诊断深静脉血栓形成（DVT）方面具有优势。然而，以前使用快速自旋回波的技术具有较高的比吸收率。由于DANTE（用于定制激发的与章动交替的延迟）黑血准备可以在很宽的速度范围内抑制血流，我们推测将DANTE黑血准备与快速低角度激发（FLASH）梯度回波读出-DANTE-FLASH相结合可用于诊断DVT。
招募了11名健康志愿者和30名疑似DVT患者，进行DANTE-FLASH和磁共振直接血栓成像（MRDTI）检查。疑似DVT患者也接受了超声（US）检查。对于节段水平，共分析了1066个静脉血管节段。以US和MRDTI作为参考，计算DANTE-FLASH的敏感性（SE）、特异性（SP）、阳性和阴性预测值（PPV和NPV）以及准确性（ACC）。为了定量比较DANTE-FLASH和MRDTI之间的图像质量，测量了图像信噪比（SNR）、肌肉与静脉腔之间的表观对比噪声比（CNR）以及血栓与静脉腔之间的表观CNR。此外，还评估了诊断置信度、图像质量和血栓负荷。
以US和MRDTI的一致结果作为标准参考，两位读者的DANTE-FLASH诊断SE、SP、PPV、NPV和ACC分别为97.0%和93.2%、99.0%和98.2%、93.4%和87.9%、99.6%和99.0%、98.8%和97.6%。根据图像定量分析结果，DANTE-FLASH显示出比MRDTI更高的图像SNR和CNR。DANTE-FLASH 的图像质量和诊断置信度评分高于MRDTI（3.66±0.44对3.52±0.52，P<0.001，以及3.84±0.36对3.76±0.41，P<0.001）。DANTE-FLASH与MRDTI在血栓负荷评估方面具有极好的一致性。
DANTE-FLASH提供了比MRDTI更好的图像质量，并能准确检测血栓。因此，它可能是诊断DVT的一种安全、便捷的替代方法。
