DCE-MRI对高危坏死股骨头微循环灌注的评价  

Evaluation of microcirculation perfusion in high-risk necrotic femoral head by DCE-MRI

作　　者：马伟丽 赵德伟[2] 王本杰[2] 杨松 杨培[3] 常晓丹[1] MA Weili;ZHAO Dewei;WANG Benjie;YANG Song;YANG Pei;CHANG Xiaodan(Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China;Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China;Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China)

机构地区：[1]大连大学附属中山医院放射科,大连116000 [2]大连大学附属中山医院骨科,大连116000 [3]华中科技大学附属武汉中心医院,武汉430014

出　　处：《磁共振成像》2019年第4期263-267,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金项目(编号:81672139)~~

摘　　要：目的通过动态增强磁共振(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)评价股骨头坏死高危人群股骨头微循环灌注的变化及正常人群股骨头内血流灌注的异质性,为超早期股骨头坏死提供影像学依据。材料与方法共选取50人60例股骨头,实验组为30例高危股骨头,对照组为30例正常股骨头,两组均行髋部DCE-MRI扫描,在股骨头负重区(前上方)、非负重区(下方)及股骨头中心区分别选取感兴趣区(region of interest,ROI),绘制百分比时间信号曲线(time-intensity curve,TIC),读取TIC上首次峰值(fEmax)、最高信号强度(Emax)、达峰时间(timetopeak,TTP)参数,通过独立样本t检验比较股骨头坏死高危人群股骨头不同ROI与正常股骨头相应区域ROI灌注参数的差异;股骨头负重区与非负重区及股骨头中心ROI灌注参数差异的比较采用方差分析。结果实验组与对照组负重区fEmax、Emax差异有统计学意义(P<0.05),实验组与对照组非负重区TTP差异有统计学意义(P<0.05),实验组与对照组股骨头中心区fEmax、Emax、TTP差异有统计学意义(P<0.05)。对照组内负重区、中心区fEmax、Emax大于非负重区fEmax、Emax,且差异有统计学意义(P<0.01),对照组内不同ROI间TTP差异无统计学意义(P>0.05)。结论股骨头坏死高危患者比正常人股骨头血流灌注低;正常人群中股骨头负重区与非负重区血流灌注具有异质性,负重区血流灌注较多。此外,高危人群股骨头血流灌注量小于健康人,灌注时间较正常股骨头长,存在血流瘀滞现象。因此,DCE-MRI可应用于指导临床进行早期预防股骨头坏死发生。Objective: To evaluate the changes of femoral head microcirculation perfusion in high-risk population of femoral head necrosis and the heterogeneity of femoral head blood perfusion in the normal femoral head by DCE-MRI, providing imaging evidence for ultralearly femoral head necrosis. Materials and Methods: Dynamic contrast-enhanced MRI of the hip was performed in 50 adults(a total of 60 cases of femoral head) with 30 cases experimental group who was high-risk patients with osteonecrosis of the femoral head. Another 30 cases of were selected as normal control group. The region of interest(ROI) was selected in the weightbearing area(anterosuperior), non-weight-bearing area(inferior) and the central area of the femoral head, and the percentage time-intensity curve(TIC) was drawn to read the maximum percentage of enhancement at first pass(fEmax), maximum percentage of enhancement at first pass(Emax), time to peak(TTP) and other related parameters. Comparison of perfusion parameters between different ROI of normal femoral head and corresponding regions of highrisk population of femoral head necrosis by independent sample t-test. Comparison of perfusion parameters between weight bearing areas, non-weight bearing areas and the center of femoral head using analysis of variance. Results: The Emax of ROI in weight-bearing area, non-weight bearing area of the control group was greater than that of high-risk group of femoral head necrosis(P<0.05). The TTP of ROI in non-load area, centre of high risk group was greater than that of the control group of femoral head necrosis(P<0.05). Another important finding was that the fEmax, Emax varied widely in the control group. fEmax and Emax were significantly greater for the weight-bearing area, the center area than for the non-weight bearing area(P<0.01). There was no significant difference in TTP between different ROI in the control group(P>0.05). Conclusions: The ROI of the patients with high risk of avascular necrosis which was decreased compared with the ROI in corresponding wit

关 键 词：股骨头坏死 磁共振成像 动态增强 微循环 血流灌注 高危人群 

分 类 号：R445.2[医药卫生—影像医学与核医学] R681.8[医药卫生—诊断学]