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Clinical Article
Application of three-dimensional dynamic contrast-enhanced magnetic resonance angiography in diagnosing lower extremity arterial disease in patients with diabetic foot
ZHANG Ji  ZHAO Xiao-er  WU Hui  XIA Jin-xiang  LIAN Hu 

DOI:10.3969/j.issn.1674-8034.2014.02.009.


[Abstract] Objective: To investigate the diagnostic value of three-dimensional dynamic contrast enhanced magnetic resonance angiography (3D CE-MRA) in lower extremity arterial disease (LEAD) of diabetic foot (DF).Materials and Methods: Fifteen diabetic cases suspected of LEAD underwent CE-MRA using 3D FLASH automatic subtraction sequence. Satisfactory lower extremity vasculars were obtained by post progressing techniques. All cases also underwent digital subtraction angiography (DSA) within one week. Stenosis grading of each segment of vascular is divided into three levels: grade A (normal/degree of stenosis < 50%), grade B (narrowed≥50%), C (block). The comprehensive diagnostic value of CE-MRA were analyzed taking DSA as the standard.Results: (1) In 15 cases, all target arteries were well demonstrated and the diagnosis was definite. (2) LEAD examined with CE-MRA were well consistent with that of DSA in DF cases (consistency check, Kappa value 0.944>0.75, P<0.05). Two medical imaging examination techniques have well consistency in diagnosing grade A and C of vascular stenosis (Kappa value 0.94, 0.84 respectively, both>0.75, both P<0.05). Two techniques have general consistency in diagnosing grade B of vascular stenosis (Kappa value 0.608, <0.75>0.4, P<0.05). (3) The positive of CE-MRA for lower extremity arterial stenosis was 96.0%, the false positive and false negative was 3.3%, 2.0% respectively;the sensitivity and specificity was 98.0%, 96.7% respectively. (4)The sensitivity of CE-MRA in diagnosing grade A, B, C of lower extremity artery stenosis of was 96.7%, 80%, 84.6% respectively, the specificity 98.0%, 92.9%, 97.1% respectively.Conclusions: 3D CE-MRA have well agreement with DSA in the positive and classification of stenosis degree for lower extremity arterial stenosis, especially grade A, C. It is unable to avoid false positives and false negatives, but CE-MRA might be performed as a routine examination method in diagnosing LEAD of DF patients, with high sensitivity, high specificity, noninvasive, no radiation, no renal toxicity and quick scaning.
[Keywords] Magnetic resonance angiography;Diabetic foot;Arterial occlusive disease;Lower extremity;Angiography, digital subtraction

ZHANG Ji Department of Magnetic Resonance Imaging, the Second People’s Hospital of Hefei City, Hefei 230011, China

ZHAO Xiao-er Department of Magnetic Resonance Imaging, the Second People’s Hospital of Hefei City, Hefei 230011, China

WU Hui Department of Magnetic Resonance Imaging, the Second People’s Hospital of Hefei City, Hefei 230011, China

XIA Jin-xiang Department of Magnetic Resonance Imaging, the Second People’s Hospital of Hefei City, Hefei 230011, China

LIAN Hu Department of Magnetic Resonance Imaging, the Second People’s Hospital of Hefei City, Hefei 230011, China

Conflicts of interest   None.

Received  2013-12-10
Accepted  2014-02-08
DOI: 10.3969/j.issn.1674-8034.2014.02.009
DOI:10.3969/j.issn.1674-8034.2014.02.009.

[1]
Arana-Conejo V, Domingo Méndez J. Physiopathology of vascular complications of diabetic foot. Gac Med Mex, 2003, 139(3): 255-264.
[2]
武宝玉,袁申元.糖尿病下肢动脉血管病变的特点及临床评价.中国综合临床, 1999, 15(4): 308-310.
[3]
张磊,金真,许樟荣.磁共振血管造影对糖尿病足及下肢动脉病变的诊断价值.中国临床康复, 2004, 18(8): 3626-3627.
[4]
LoGerfo FW, Gibbons GW. Vascular disease of the lower extremities in diabetes Mellitus. Endocrinol Metab Clin North Am, 1996, 25(2):439-445.
[5]
Dorweiler B, Neufang A, Kreitner KF, et al. Magnetic resonance angiography Unmasks reliable target vessels for pedal bypass grafting in patients with diabetes mellitus. J Vasc Surg, 2002, 35(4): 766-772.
[6]
Cronberg CN, Sjoberg S, Albrechtsson U, et al. Peripheral arterial disease: contrast-enhanced 3D MR angiography of the lower leg and foot compared with conventional angiography. Acta Radiological, 2003, 44(1): 59-66.
[7]
Jurgen K, Bernhard BA. Aortoiliac and lower extremity arteries assessed with 16-detector row CT angiography: prospective comparison with digital subtraction angiography. Radiology, 2005, 236(4): 1083-1093.
[8]
王朝阳. CTA诊断糖尿病下肢动脉病变的临床应用评价.实用医学影像杂志, 2011, 12(2): 104-106.
[9]
Heijenbrok-Kal MH, Kock MC, Hunink MG. Lower extremity arterial disease: multidetector CT angiography meta-analysis. Radiology, 2007, 245(2): 433-439.
[10]
王华,王伯胤.糖尿病足下肢动脉病变影像学诊断研究进展. Chin Gener Practi, 2010, 13(8B): 2543-2546.
[11]
郭娟,王效春,张辉,等.三维动态增强MR血管成像在显示下肢动脉硬化闭塞症侧支循环形成中的应用价值.磁共振成像, 2012, 3(3): 200-203.
[12]
孙红海,刘新爱,史志勇. MR三维动态增强成像在下肢动脉血管的临床应用.磁共振成像, 2012, 3(4): 278-281.
[13]
陈标.三维动态增强磁共振血管成像诊断下肢血管病变65例分析.实用医院临床杂志, 2013, 10(4): 101-102.
[14]
应琦,彭志毅,樊树峰,等. MR时间分辨对比剂动态增强技术在糖尿病足下肢血管病变中的诊断价值:与DSA对照.中国医学影像技术, 2010, 26(8): 1466-1469.

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