磁共振成像活动性分级与体素内不相干运动在克罗恩病临床评估中的应用  

Magnetic Resonance for Evaluation of Disease Activity in Patients with Crohn’s Disease:Validation of Grading System and Intravoxel Incoherent Motion Imaging

作　　者：张彩红 向丽园 朱建国[1] 崔伯塔[2] 郭会映[1] 李海歌[1] ZHANG Caihong;XIANG Liyuan;ZHU Jianguo(Department of Medical Imaging,The Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210011,P.R.China)

机构地区：[1]南京医科大学第二附属医院医学影像科,210011 [2]南京医科大学第二附属医院消化医学中心,210011

出　　处：《临床放射学杂志》2021年第8期1539-1544,共6页Journal of Clinical Radiology

基　　金：江苏省卫健委高层次卫生人才“六个一工程”科研项目(编号:LGY2018072);江苏省高等学校自然科学研究项目(编号:18KJB310007)。

摘　　要：目的评价基于磁共振肠道成像(MRE)的评级方法与体素内不相干运动(IVIM)在克罗恩病(CD)病变活动程度判别、评估中的作用。方法采用回顾性研究方法,搜集肠道CD患者72例,男44例,女28例,平均年龄(36.43±13.04)岁。所有患者接受3.0 T MRI检查,包括常规MRE及IVIM检查,同时搜集患者的临床资料,如简易内镜评分(SES-CD)、C反应蛋白(CRP)、红细胞沉降率(ESR)。IVIM扫描区域位于病变最严重肠段,采集的参数包括标准表观扩散系数(ADC_(standard))、慢速扩散ADC(ADC_(slow))、快速扩散ADC(ADC_(fast))和快速扩散ADC分数(Fraction of ADC_(fast))。对患者进行临床综合评分(HBI),依据评分结果将患者分为三组(活动缓解期、中度活动期和重度活动期)。运用Kruskal-Wallis H和χ^(2)检验比较MRI活动性分级、IVIM参数及临床资料的三组间差异;MRI活动性分级和HBI及临床数据的相关性检验采用Spearman检验;采用多元有序Logistic回归分析多参数对判别CD病变活动程度的作用。结果随病变活动加重,SES-CD(P<0.001)、CRP(P=0.001)、ESR(P=0.042)、MRI活动性分级(P=0.047)和ADC_(fast)(P=0.020)显著升高,而Fraction of ADC_(fast)显著降低(P=0.021)。MRI活动性分级与HBI、SES-CD统计学正相关(r=0.341,P=0.003;r=0.287,P=0.014)。有序Logistic回归显示SES-CD、CRP和ADC_(fast)有助于CD病变活动性判别。结论基于MRE的活动性分级和IVIM具有无创、定量的特性,结合临床指标,能够应用于CD的活动性评估。Objective To investigate the effect of grading system based on MR entrography(MRE)and intravoxel incoherent motion imaging(IVIM)parameters for evaluation of disease activity in Crohn’s disease(CD).Methods Total of 72 patients with CD[median age(36.43±13.04)years;44 males and 28 females]were enrolled in current retrospective study.All patients performed 3.0 T MRI scanning including conventional MR enterography(MRE)and intravoxel incoherent motion imaging(IVIM).Clinical data(simplified endoscopic score for Crohn’s disease,SES-CD;C-reactive protein,CRP;erythrocyte sedimentation rate,ESR)of each patient was also collected.IVIM parameters such as standard apparent diffusion coefficient(ADC)and ADC_(slow)、ADC_(fast) and Fraction of Fast ADC were derived from the most inflamed bowel segments identified by the presence of inflammatory changes.Harvey-Bradshaw index at the time of MRE was set as reference for assessment of disease activity(remission,moderate and severe),and the cohort was divided into three different groups.MRI activity grading scores,IVIM parameters and clinical data were compared using Kruskal-Wallis H and χ^(2) test.MRI activity grading scores were correlated with clinical references(HBI and SES-CD)using Spearman’s rank.A multivariate ordinal regression model was built to analyze the possibly factors in discriminating disease activity level.Results SES-CD(P<0.001),CRP(P=0.001),ESR(P=0.042),MRI activity grading scores(P=0.047)and ADC_(fast)(P=0.020)were significantly increased,while fraction of Fraction of Fast ADC was significantly decreased(P=0.021)in moderate and severe groups.MRI activity grading scores were significantly correlated with HBI and SES-CD(r=0.341,P=0.003;r=0.287,P=0.014).Three factors(SES-CD,CRP and ADC_(fast))contributed to discriminate disease activity level.Conclusion Grading system and IVIM based on MRE,particularly when used in combination with clinical data,are promising for non-invasive evaluation of CD.

关 键 词：磁共振肠道成像 活动性分级 体素内不相干运动 克罗恩病 病变活动 

分 类 号：R445.2[医药卫生—影像医学与核医学] R574.62[医药卫生—诊断学]