Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.
Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
J Vasc Surg Venous Lymphat Disord. 2022 Sep;10(5):1087-1094. doi: 10.1016/j.jvsv.2022.04.008. Epub 2022 May 26.
In the present retrospective, assessor-blinded cross-sectional study, we compared the diagnostic efficacy of the relaxation-enhanced angiography without contrast and triggering (REACT) protocol for magnetic resonance venography (MRV) and intravascular ultrasound (IVUS).
All patients without prior lower limb vascular stenting who had undergone MRV with the REACT protocol and IVUS at our institution from January 2018 to May 2020 were included. The REACT protocol for MRV comprises three main phases: the adiabatic-based T2-preparation module, the non-volume-selective short tau inversion recovery pulse sequence, and the three-dimensional, modified two-point chemical-shift water-fat separated turbo-field echo pulse sequence. The IVUS findings served as the reference standard for stenosis and were used in the diagnostic efficacy analysis of the REACT protocol for MRV. The REACT protocol MRV images were reviewed by three board-certified interventional radiologists, and an interrater analysis was performed.
A total of 33 patients (110 segments with IVUS correlation; 18 men [54.5%] and 15 women [45.5%]) were included. Most patients were Chinese (63.6%), and 24 had had bilateral deep venous disease (72.7%). The mean patient age was 59.0 years (range, 26.0-79.5 years). Moderate agreement was found between the three radiologists' diagnoses of iliac vein pathology using the REACT protocol for MRV (κ = 0.524; 95% confidence interval [CI], 0.426-0.623; P < .001). Compared with IVUS, REACT protocol MRV achieved a sensitivity of 96.10% (95% CI, 89.03%-99.19%), specificity of 78.79% (95% CI, 61.09%-91.02%), positive predictive value of 91.36% (95% CI, 84.54%-95.33%), and negative predictive value of 89.66% (95% CI, 73.81%-96.38%). Overall, 78.5% agreement was noted between the REACT protocol MRV and IVUS findings. Good agreement between the index test and reference standard was noted (κ = 0.779; 95% CI, 0.645-0.907; P ≤ .05).
REACT protocol MRV has the potential to be a highly sensitive and specific screening tool to diagnose deep venous disease.
在本回顾性、评估者盲法的横断面研究中，我们比较了磁共振静脉造影（MRV）和血管内超声（IVUS）的弛豫增强无对比剂触发（REACT）协议的诊断效能。
纳入 2018 年 1 月至 2020 年 5 月在我院接受 REACT 协议 MRV 和 IVUS 检查且无下肢血管支架植入术史的所有患者。REACT 协议 MRV 包括三个主要阶段：基于绝热的 T2 准备模块、非容积选择短 tau 反转恢复脉冲序列和三维、改良两点化学位移水脂分离涡轮场回波脉冲序列。IVUS 结果作为狭窄的参考标准，并用于分析 REACT 协议 MRV 的诊断效能。由三位经过认证的介入放射科医生对 REACT 协议 MRV 图像进行评估，并进行了组内一致性分析。
共纳入 33 例患者（110 个节段与 IVUS 相关；18 例男性[54.5%]和 15 例女性[45.5%]）。大多数患者为中国人（63.6%），24 例患者存在双侧下肢深静脉疾病（72.7%）。患者平均年龄为 59.0 岁（范围 26.0-79.5 岁）。三位放射科医生对髂静脉病变的诊断采用 REACT 协议 MRV 时，具有中度一致性（κ=0.524；95%置信区间[CI]，0.426-0.623；P<.001）。与 IVUS 相比，REACT 协议 MRV 的敏感性为 96.10%（95%CI，89.03%-99.19%），特异性为 78.79%（95%CI，61.09%-91.02%），阳性预测值为 91.36%（95%CI，84.54%-95.33%），阴性预测值为 89.66%（95%CI，73.81%-96.38%）。总体而言，REACT 协议 MRV 与 IVUS 结果之间有 78.5%的一致性。REACT 协议 MRV 与参考标准之间具有良好的一致性（κ=0.779；95%CI，0.645-0.907；P≤0.05）。
REACT 协议 MRV 有可能成为一种高度敏感和特异的深静脉疾病筛查工具。
