动态对比增强磁共振在糖尿病足骨髓炎中的应用价值  

The Application Value of Dynamic Contrast-Enhanced MRI in Diabetic Foot Osteomyelitis

作　　者：廖旦[1] 谢利秋 张志伟[1] 罗琦[1] 李咏梅[1] LIAO Dan;XIE Liqiu;ZHANG Zhiwei(Department of Radiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,P.R.China)

机构地区：[1]重庆医科大学附属第一医院放射科

出　　处：《临床放射学杂志》2018年第8期1347-1351,共5页Journal of Clinical Radiology

基　　金：国家临床重点专科建设项目([2013]544)

摘　　要：目的探讨动态对比增强磁共振成像（DCE-MRI）在糖尿病足（DF）骨髓炎中的应用价值及与血清检验指标C反应蛋白（CRP）及血沉（ESR）的相关性。方法搜集30例经临床综合诊断的DF骨髓炎患者的实验室血清检查、足部常规MRI和DCE-MRI检查资料。运用动态增强血流动力学软件测量足部骨髓炎及非骨髓炎区DCE定量参数值,包括容积转移常数（K^trans）、血管外细胞外间隙容积分数（Ve）、速率常数（K（ep））。采用t检验比较分析骨髓炎及非骨髓炎区各参数的差异,并与血清学检查各指标之间进行相关性分析。采用受试者工作特征曲线（ROC）分析K^trans、K（ep）、Ve对于骨髓炎及非骨髓炎区的鉴别能力。结果骨髓炎区定量参数K^trans、K（ep）、Ve值分别为（0.819±1.172）min^-1、（1.191±0.853）min^-1、0.483±0.328。DF患者骨髓炎区定量参数K^trans、K（ep）、Ve值明显高于非骨髓炎区。Pearson相关分析显示DF患者骨髓炎区域灌注参数K^trans、K（ep）、Ve与CRP及ESR呈正相关。ROC显示K^trans、Ve值对DF骨髓炎的鉴别诊断效能高于K（ep）值。结论 DCE-MRI定量参数可以评价DF骨髓炎的严重程度,对于临床监测疗效及评估预后具有重要价值。Objective To investigate the application value of dynamic contrast-enhanced magnetic resonance imaging（ DCE-MRI） in diabetic foot osteomyelitis and its correlation with clinical laboratory examination CRP and ESR. Methods Thirty patients with the comprehensive clinical diagnosis of DF osteomyelitis underwent laboratory examination,conventional MRI and DCE-MRI. Quantitative parameters including the volume transfer constant（ K^trans）,rate constant（ K（ep））,extravascular extracellular volume fraction（ Ve） of diabetic foot osteomyelitis regions and non-osteomyelitis regions were derived from DCE-MRI data,quantitative parameters between the two regions were analyzed by using Student t test. The Relationship between quantitative parameters and ESR and CRP were analyzed by using correlation analysis. We also used the the receiver operating characteristic curve to analyse the identification ability of K^trans、K（ep）、Ve in osteomyelitis and non-osteomyelitis regions. Results The quantitative parameters K^trans、K（ep）,and Ve of the osteomyelitis regions were（ 0. 819 ±1. 172） ml/min,（ 1. 191 ± 0. 853） ml/min,（ 0. 483 ± 0. 328） ml/min,（ 0. 101 ± 0. 054） ml/min respectively. The quantitative parameters in osteomyelitis regions were significantly higher than that in non-osteomyelitis region. Pearson correlation analysis showed that K^trans、K（ep）、Ve were correlated with CRP and ESR. The ROC analysis showed that K^transand Ve are better than K（ep）for the diagnosis of diabetic foot osteomyelitis. Conclusion The parameters of DCE-MRI can quantitatively evaluate the degree of inflammation of osteomyelitis in the diabetic foot,and it has great value in monitoring and evaluating the disease prognosis.

关 键 词：磁共振成像 骨髓炎 动态增强 糖尿病足 

分 类 号：R445.2[医药卫生—影像医学与核医学] R587.2[医药卫生—诊断学]