Johnson D B, Lerner C A, Prince M R, Kazanjian S N, Narasimham D L, Leichtman A B, Cho K J
Department of Radiology, University of Michigan, Ann Arbor 48109-0030, USA.
Magn Reson Imaging. 1997;15(1):13-20. doi: 10.1016/s0730-725x(96)00348-7.
Our purpose was to investigate three-dimensional (3D) gadolinium-enhanced magnetic resonance angiography (Gd-MRA) in the evaluation of renal transplant arteries. Eleven MR angiography examinations were performed in nine renal transplant patients. Gd-MRA, three-dimensional phase contrast (3D-PC) post-gadolinium, and two-dimensional time-of-flight (2D-TOF) MR angiography were performed and independently reviewed by three vascular radiologists who, for each MR angiography sequence, separately graded occlusive disease in the ipsilateral iliac artery, the transplant artery anastomosis, and the transplant artery itself. The Gd-MRA and 3D-PC data were reviewed as maximum intensity projections (MIP) reconstructed in standard planes, and the 2D-TOF data were interpreted from source images. In addition, a single vascular radiologist prospectively interpreted the Gd-MRA and 3D-PC data together, hereinafter Gd/PC, from MIP reconstructions for each case. In all of these patients either surgical (n = 3) or angiographic studies (n = 8) were performed within 21 days following the MR examination, which served as a reference standard to determine sensitivity and specificity. The sensitivity/specificity for the detection of significant stenosis were as follows: Gd-MRA, 67/88; 3D-PC, 60.3/76.6; 2D-TOF, 47/81; and Gd/PC, 100/100. The kappa statistic (kappa) for interobserver agreement for the grading of stenoses by 2D-TOF, Gd-PC, and Gd-MRA was 0.48, 0.60, and 0.74, respectively. The percentage of all vascular segments seen well enough to grade (cumulative for all three observers) was 94%, 85%, and 79% for Gd-MRA, 3D-PC, and 2D-TOF, respectively. The combination of Gd-MRA and 3D-PC is a promising approach to the evaluation of transplant renal arteries.
我们的目的是研究三维（3D）钆增强磁共振血管造影（Gd-MRA）在评估肾移植动脉中的应用。对9例肾移植患者进行了11次磁共振血管造影检查。分别进行了Gd-MRA、钆增强后三维相位对比（3D-PC）和二维时间飞跃（2D-TOF）磁共振血管造影，并由三位血管放射科医生独立进行评估。对于每个磁共振血管造影序列，三位医生分别对同侧髂动脉、移植动脉吻合口和移植动脉本身的闭塞性疾病进行分级。Gd-MRA和3D-PC数据作为在标准平面重建的最大强度投影（MIP）进行评估，2D-TOF数据则从原始图像进行解读。此外，一名血管放射科医生对每个病例的MIP重建图像中的Gd-MRA和3D-PC数据（以下简称Gd/PC）进行前瞻性联合评估。在所有这些患者中，在磁共振检查后的21天内进行了手术（n = 3）或血管造影研究（n = 8），这些检查作为确定敏感性和特异性的参考标准。检测显著狭窄的敏感性/特异性如下：Gd-MRA为67/88；3D-PC为60.3/76.6；2D-TOF为47/81；Gd/PC为100/100。2D-TOF、Gd-PC和Gd-MRA对狭窄分级的观察者间一致性kappa统计量分别为0.48、0.60和0.74。Gd-MRA、3D-PC和2D-TOF能充分观察到并进行分级的所有血管节段的百分比（三位观察者累计）分别为94%、85%和79%。Gd-MRA和3D-PC联合应用是评估移植肾动脉的一种有前景的方法。
