Value of non-contrast-enhanced MR angiography combined with captopril renal scintigraphy in the diagnosis of renovascular hypertension

中华核医学与分子影像杂志 Pub Date : 2020-02-25 DOI:10.3760/CMA.J.ISSN.2095-2848.2020.02.005

Li-gen Duan, Xiemei Ruan, Xinyu Wu, Junling Xu

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Abstract

Objective To evaluate the clinical value of non-contrast-enhanced MR angiography (NCE-MRA) combined with captopril renal scintigraphy (CRS) in the diagnosis of renovascular hypertension (RVH). Methods A total of 52 patients (33 males, 19 females; age: (54.5±16.3) years) with highly suspected RVH between January 2018 and October 2018 from Henan Provincial People′s Hospital were retrospectively analyzed. The examination data of NCE-MRA, basic renal dynamic imaging, CRS and digital subtraction angiography (DSA) were collected and reviewed. The renal artery stenosis (RAS) rate≥70% was the criterion for RVH diagnosed by DSA, which was considered as the gold standard. The diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of NCE-MRA, CRS and NCE-MRA+ CRS were determined. The consistency between NCE-MRA and DSA was analyzed by Kappa test. The differences of diagnostic efficiencies between CRS and NCE-MRA + CRS were compared by χ2 test or Fisher exact test. Results There was a high consistency between NCE-MRA and DSA in the diagnosis of RVH (Kappa=0.81, 95% CI: 0.62-0.96; P<0.01). The diagnostic sensitivity, specificity, accuracy, PPV and NPV of NCE-MRA were 88.89%(24/27), 92.00%(23/25), 90.38%(47/52), 92.31%(24/26), and 88.46%(23/26) respectively, those of CRS were 81.48%(22/27), 72.00%(18/25), 76.92%(40/52), 75.86%(22/29) and 78.26%(18/23) respectively, and those of NCE-MRA+ CRS were 74.07%(20/27), 100%(25/25), 86.54%(45/52), 100%(20/20) and 78.12%(25/32) respectively. Compared with CRS, the specificity (P=0.01) and PPV (P=0.03) of NCE-MRA+ CRS in the diagnosis of RVH were increased. Conclusion NCE-MRA and CRS are effective in the diagnosis of RVH, and the combination of two methods can significantly improve the diagnostic specificity and PPV than CRS alone. Key words: Hypertension, renovascular; Radionuclide imaging; Captopril; Technetium Tc 99m pentetate; Magnetic resonance imaging

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非增强MR血管造影联合卡托普利肾显像对肾血管性高血压的诊断价值

目的探讨非对比增强MR血管造影(NCE-MRA)联合卡托普利肾显像(CRS)诊断肾血管性高血压(RVH)的临床价值。方法52例患者(男33例，女19例;回顾性分析2018年1月至2018年10月河南省人民医院收治的高度疑似RVH患者(54.5±16.3)岁。收集并复习NCE-MRA、基本肾动态成像、CRS、数字减影血管造影(DSA)的检查资料。肾动脉狭窄(RAS)率≥70%为DSA诊断RVH的标准，作为金标准。测定NCE-MRA、CRS及NCE-MRA+ CRS的诊断敏感性、特异性、准确性、阳性预测值(PPV)和阴性预测值(NPV)。采用Kappa检验分析NCE-MRA与DSA的一致性。采用χ2检验或Fisher精确检验比较CRS与NCE-MRA + CRS诊断效率的差异。结果NCE-MRA与DSA诊断RVH的一致性较高(Kappa=0.81, 95% CI: 0.62 ~ 0.96;P < 0.01)。NCE-MRA的诊断敏感性、特异性、准确性、PPV和NPV分别为88.89%(24/27)、92.00%(23/25)、90.38%(47/52)、92.31%(24/26)和88.46%(23/26)，CRS的诊断敏感性、特异性、准确性、PPV和NPV分别为81.48%(22/27)、72.00%(18/25)、76.92%(40/52)、75.86%(22/29)和78.26%(18/23)，NCE-MRA+ CRS的诊断敏感性、特异性、准确性和PPV、NPV分别为74.07%(20/27)、100%(25/25)、86.54%(45/52)、100%(20/20)和78.12%(25/32)。与CRS相比，NCE-MRA+ CRS诊断RVH的特异性(P=0.01)和PPV (P=0.03)均有所提高。结论NCE-MRA和CRS对RVH的诊断是有效的，两种方法联合使用比单独CRS可显著提高诊断特异性和PPV。关键词:高血压;肾血管性;放射性核素成像;卡托普利;锝Tc 99m渗透;磁共振成像

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来源期刊

中华核医学与分子影像杂志核医学，分子影像

自引率

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发文量

5088

期刊介绍： Chinese Journal of Nuclear Medicine and Molecular Imaging (CJNMMI) was established in 1981, with the name of Chinese Journal of Nuclear Medicine, and renamed in 2012. As the specialized periodical in the domain of nuclear medicine in China, the aim of Chinese Journal of Nuclear Medicine and Molecular Imaging is to develop nuclear medicine sciences, push forward nuclear medicine education and basic construction, foster qualified personnel training and academic exchanges, and popularize related knowledge and raising public awareness. Topics of interest for Chinese Journal of Nuclear Medicine and Molecular Imaging include: -Research and commentary on nuclear medicine and molecular imaging with significant implications for disease diagnosis and treatment -Investigative studies of heart, brain imaging and tumor positioning -Perspectives and reviews on research topics that discuss the implications of findings from the basic science and clinical practice of nuclear medicine and molecular imaging - Nuclear medicine education and personnel training - Topics of interest for nuclear medicine and molecular imaging include subject coverage diseases such as cardiovascular diseases, cancer, Alzheimer’s disease, and Parkinson’s disease, and also radionuclide therapy, radiomics, molecular probes and related translational research.