MRI前方软骨性头臼覆盖率在评价发育性髋关节发育不良治疗后髋关节功能的价值  

The value of MRI anterior cartilaginous acetabulum-head-index to evaluate hip function after treatment of developmental dysplasia of the hip

作　　者：张雯双 王延宙[2] 李天友 孙聪 栾钦花[1] 班永光[1] 陈昱帆 杨奡偲 李晔[1] 王光彬[1] Zhang Wenshuang;Wang Yanzhou;Li Tianyou;Sun Cong;Luan Qinhua;Ban Yongguang;Chen Yufan;Yang Aocai;Li Ye;Wang Guangbin(Department of Radiology,Shandong Medical Imaging Research Institute,Cheeloo College of Medicine,Shandong University,Jinan 250021,China;Department of Child Orthopaedics,Shandong Provincial Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属山东省医学影像学研究所,济南250021 [2]山东大学附属山东省立医院小儿骨科,济南250021

出　　处：《中华放射学杂志》2021年第10期1076-1081,共6页Chinese Journal of Radiology

摘　　要：目的探讨基于髋关节高分辨MRI测量的股骨头前方软骨性头臼覆盖率(A-CAHI)评价发育性髋关节发育不良(DDH)患儿治疗后髋关节功能的价值。方法回顾性收集2019年1月至2020年1月于山东省医学影像学研究所复诊的61例DDH患儿,共92个患侧髋关节。所有患儿3年前均行保守或手术治疗,分为治疗后髋关节功能优良组(McKay髋功能评定Ⅰ、Ⅱ级,n=46)和髋关节功能中差组(McKay髋功能评定Ⅲ、Ⅳ级,n=46)。所有患儿均行髋关节斜矢状面高分辨脂肪抑制质子密度加权像(FS-PDWI)和常规序列扫描。于FS-PDWI图像测量A-CAHI,于冠状面T1WI测量侧方软骨性头臼覆盖率(L-CAHI),于骨盆正位片测量骨性头臼覆盖率(AHI)。采用Mann-Whitney U检验或独立样本t检验比较不同髋关节临床功能分组间A-CAHI、L-CAHI、AHI的差异,并采用ROC曲线评估A-CAHI、L-CAHI、AHI及A-CAHI联合L-CAHI对髋关节功能的诊断效能,ROC曲线下面积(AUC)的比较采用Z检验。结果髋关节功能中差组A-CAHI、L-CAHI、AHI较优良组减低,差异均有统计学意义(Z=-7.746、-7.735,t=-7.199,P均<0.001)。A-CAHI、L-CAHI、AHI、A-CAHI联合L-CAHI评价髋关节功能的AUC分别为0.969、0.968、0.861、0.994。A-CAHI联合L-CAHI的AUC高于A-CAHI、L-CAHI、AHI单独诊断AUC,差异均有统计学意义(Z=1.975、2.006、3.553,P=0.048、0.045、<0.001),其灵敏度、特异度分别为95.7%、97.8%。结论应用MRI高分辨成像测量的患侧髋关节A-CAHI可有效评价DDH治疗后髋关节功能,联合L-CAHI能够进一步提高诊断效能。Objective To evaluate the feasibility of high resolution MRI for the measurement of anterior cartilaginous acetabulum-head-index(A-CAHI)and the value of A-CAHI for predicting hip clinical function after treatment in developmental dysplasia of the hip(DDH).Methods The imaging data of 92 hips from 61 children with treated DDH were retrospectively reviewed in Shandong Medical Imaging Research Institute from January 2019 to January 2020.All children underwent conservative treatments or surgical interventions 3 years ago.Hip function after treatment was evaluated clinically based on the modified MacKay criteria.The hips were divided into satisfactory clinical function group(McKay rating excellent or good,n=46)and unsatisfactory group(McKay rating fair or poor,n=46).All patients were imaged with conventional MRI,high resolution fat suppressed proton density weighted image(FS-PDWI)of the unilateral hip joint in oblique sagittal view,and anteroposterior hip radiographs.A-CAHI and lateral cartilaginous acetabulum-head-index(L-CAHI)were measured respectively on high-resolution oblique sagittal PDWI and conventional coronal T1WI.Acetabulum head index(AHI)was also measured on anteroposterior hip radiograph.Mann-Whitney U test or independent-samples t test was used to compare the difference of A-CAHI,L-CAHI and AHI between satisfactory and unsatisfactory clinical function groups.The diagnostic value using A-CAHI,L-CAHI,AHI,or A-CAHI combined with L-CAHI for unsatisfactory clinical function were investigated by the ROC curve.The area under the curve(AUC)and the Z statistic were used to compare diagnostic performance.Results The values of A-CAHI,L-CAHI and AHI were significantly higher in satisfactory clinical function group compared with the unsatisfactory group(Z=-7.746,-7.735,t=-7.199,all P<0.001).A-CAHI combined with L-CAHI had the significant highest diagnostic accuracy compared with A-CAHI,L-CAHI and AHI(AUC were 0.994,0.969,0.968,0.861,respectively),with significant differences(Z=1.975,2.006,3.553,P=0.048,0.051,<0.001).T

关 键 词：磁共振成像 发育性髋关节发育不良 软骨性头臼覆盖率 

分 类 号：R726.8[医药卫生—儿科]