MAGiC短时反转恢复序列诊断骶髂关节炎骨髓水肿的价值  

The value of MAGiC short T1 inversion recovery sequence in the detection of bone marrow edema in sacroiliitis

作　　者：姜云萍 李文娟[1] 占颖莺 郑晶[2] 张珂 廖娟 罗浩 张雷 李绍林[1] 洪国斌[1] Jiang Yunping;Li Wenjuan;Zhan Yingying;Zheng Jing;Zhang Ke;Liao Juan;Luo Hao;Zhang Lei;Li Shaolin;Hong Guobin(Department of Radiology,the Affiliated Fifth Hospital of Sun Yat-sen University,Zhuhai 519000,China;Department of Rheumatology,the Affiliated Fifth Hospital of Sun Yat-sen University,Zhuhai 519000,China;Enhance Application of Team of GE Healthcare,Guangzhou 510000,China)

机构地区：[1]中山大学附属第五医院放射科,珠海519000 [2]中山大学附属第五医院风湿免疫科,珠海519000 [3]通用电气医疗磁共振高级临床应用培训部,广州510000

出　　处：《中华放射学杂志》2021年第1期59-63,共5页Chinese Journal of Radiology

摘　　要：目的探讨MAGiC STIR序列在强直性脊柱炎(AS)患者骶髂关节骨髓水肿(BME)中的诊断价值。方法前瞻性连续收集2019年9月至2020年1月在中山大学附属第五医院确诊的AS患者22例。对所有患者均行骶髂关节MR常规序列和MAGiC序列扫描。在斜冠状面图像上将每个骶髂关节分为4个区域。两名从事骨肌影像诊断的高、中年资医师(医师1、医师2)采用Hermann-Braun评分系统分别独立对T2WI脂肪抑制(FS)序列和MAGiC短时反转恢复序列(STIR)图像进行BME评分,并统计两个序列检出BME的区域个数,意见不同时通过协商达成一致。医师2于两周后对MAGiC STIR序列图像再次进行BME评分。采用组内相关系数(ICC)分析MAGiC STIR序列BME评分医师内和医师间的一致性以及MAGiC STIR序列检出BME区域个数的医师间一致性;采用Wilcoxon符号秩和检验比较两个序列BME评分的差异。采用χ²检验比较两个序列检出BME区域个数的差异。以T2WI FS序列结果作为参考标准,计算MAGiC STIR序列诊断BME的ROC曲线下面积和灵敏度、特异度、阳性预测值、阴性预测值。结果本研究最终纳入19例AS患者,共计38个骶髂关节,划分为152个区域。MAGiC STIR序列医师间及医师内BME评分的一致性好(ICC=0.936,95%CI 0.912~0.953,P<0.001;ICC=0.910,95%CI 0.878~0.934,P<0.001);两组序列BME评分差异具有统计学意义(Z=-3.132,P=0.002)。MAGiC STIR序列检出BME区域个数的医师间一致性好(ICC=0.876,95%CI 0.833~0.909,P<0.001);两个序列检出BME区域个数差异无统计学意义(χ²=0.244,P=0.622)。MAGiC STIR序列诊断BME的曲线下面积为0.920(P<0.001),灵敏度、特异度、阳性预测值及阴性预测值分别为82.0%、95.1%、89.1%和91.5%。结论MAGiC STIR序列可用于评估AS患者骶髂关节炎BME,且灵敏度和特异度较高。Objective To evaluate the value of MAGiC STIR sequence inassessing bone marrow edema(BME)of the sacroiliac joint(SIJ)in ankylosing spondylitis(AS)patients.Methods Twenty two AS patients from the Affiliated Fifth Hospital of Sun Yat-sen University from September 2019 to January 2020 underwent MR scanning,consisting of T2WI fat-suppressed(FS)sequence and MAGiC sequence.Each SIJ was divided into four quadrants for analysis on oblique coronal MR image.Two radiologists[middle-higher seniority levels(radiologist 1 and radiologist 2)reviewed image sets of two sequences[T2WI FS and MAGiC short T1 inversion recovery(STIR)sequence]independently at separate times,using Hermann-Braun scoring system for degree of BME and summing numbers of quadrants based on BME findings.Disagreements were resolved to reach an agreement for final results.Assessments were repeated two weeks later by radiologist 2.Intra-class correlation coefficients(ICC)were calculated to assess the inter-and intra-observer agreement for the degree of BME and numbers of positive BME quadrants in the MAGiC STIR sequence,respectively.The differences between the two sequences for the degree of BME and numbers of positive BME quadrants were analyzed with Wilcoxon signed-rank test and Chi-square test,respectively.Taking the results of T2WI FS sequence as a reference standard,the ROC curve was drawn,sensitivity,specificity,positive predictive value and negative predictive value in the detection of BME were calculated for the MAGiC STIR sequence.Results Nineteen AS patients including 38 sacroiliac joints were enrolled in our study,being divided into 152 quadrants.Inter-and intra-observer agreement for the degree of BME and inter-observer agreement for numbers of positive BME quadrants in the MAGiC STIR sequence were all good(ICC=0.936,95%CI 0.912-0.953,P<0.001;ICC=0.910,95%CI 0.878-0.934,P<0.001;ICC=0.876,95%CI 0.833-0.909,P<0.001).The difference between the two sequences for the degree of BME in quadrants was statistically significant(Z=-3.132,P=0.002).But there was

关 键 词：骨髓 水肿 骶髂关节炎 磁共振成像 MAGiC序列 

分 类 号：R593.23[医药卫生—内科学] R445.2[医药卫生—临床医学]