体素内不相干运动磁共振成像检测类风湿性腕关节滑膜炎的研究  

A study of IVIM magnetic resonance imaging to identify wrist synovitis in rheumatoid arthritis

作　　者：李生虎[1] 蒋兆贯[1] LI Shenghu;JIANG Zhaoguan(Department of Radiology,Wuxi Hospital of Traditional Chinese Medicine,Wuxi 214071,China)

机构地区：[1]无锡市中医医院放射科,无锡214071

出　　处：《磁共振成像》2022年第4期132-136,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：江苏省无锡市卫生健康委员会青年项目(编号:Q201910)。

摘　　要：目的评估体素内不相干运动(intravoxel incoherent motion,IVIM)扩散成像检测类风湿性腕关节滑膜炎的可行性。材料与方法本前瞻性研究招募类风湿性关节炎志愿者13例,男1例,女12例,年龄26~74岁,中位年龄47岁。所有患者均进行包含质子密度加权频率衰减翻转恢复序列(proton density weighted-spectral attenuated inversion recovery,PDW-SPAIR)、动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)、IVIM序列的3.0 T磁共振检查,扫描范围包含尺桡骨远端、腕关节及第1~5掌指关节。手动绘制感兴趣区(regions of interest,ROI),首先在冠状位PDW-SPAIR序列图像中绘制,随后复制或标记到扩散加权成像(diffusion weighted imaging,DWI)和增强图像中,并尽可能保持解剖位置相同。图像判读由三位影像诊断医生分别进行。表观扩散系数(apparent diffusion coefficient,ADC)值、渗透分析数据(Ktrans、Kep、Ve、Vp)和IVIM参数(f、D*、D)由专用软件自动获取。观察者间一致性评估选用Fleiss Kappa分析,采用Spearman相关系数比较各测量参数之间的相关性。利用受试者工作特征(receiver operating characteristic curve,ROC)曲线下面积(area under the curve,AUC)值比较各个定量参数鉴别有无滑膜增厚的诊断价值。AUC值差异比较采用Delong检验对比分析。P<0.05认为差异具有统计学意义。结果观察者间一致性良好(Kappa值=0.718,95%CI:0.717~0.720,P<0.05)。强化程度与Ktrans呈正相关关系(r=0.933,P<0.05),与ADC值、D值呈负相关关系(r=-0.451、r=-0.520,P<0.05),Kep、Ve、Vp、f和D*值在鉴别滑膜增厚方面差异无统计学意义(P>0.05)。Ktrans与ADC值、D值存在相关性,r分别为-0.395(95%CI:-0.532~-0.212)、-0.489(95%CI:-0.609~-0.342),P<0.05。参数D的AUC值(0.793,95%CI:0.712~0.873)大于参数ADC的AUC值(0.706,95%CI:0.602~0.810)且差异存在统计学意义。结论IVIM磁共振成像可用于检测类风湿性腕关节滑膜炎。Objective:To assess the feasibility of intravoxel incoherent motion(IVIM)magnetic resonance imaging for the detection of synovial thickening of the wrist in patients with rheumatoid arthritis.Materials and Methods:Thirteen patients(mean age 47 years,range 26 to 74 years)with a definite diagnosis of active rheumatoid arthritis were recruited.All patients underwent 3.0 T MRI including proton density weighted-spectral attenuated inversion recovery(PDW-SPAIR),dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and IVIM.Scanning range includes the distal ulnar radius,wrist joint and 1-5 metacarpophalangeal joints.Region of interests were manually drawn on high signal regions in coronal PDW-SPAIR,and copied to the same position of diffusion weighted imaging(DWI)and enhancement images by three different radiologists.ADC values,permeability parameters(Ktrans,Kep,Ve,Vp)and IVIM parameters(f,D*,D)were automatically acquired and recorded.Interobserver agreement was assessed using Fleiss Kappa analysis.The relationship between MRI enhancement results and ADC values,quantitative permeability parameters,quantitative IVIM data were evaluated using Spearman correlation coefficient.The ability of each permeability parameter to identify synovial thickening was evaluated using the area under the ROC curve(AUC).The AUCs were furtherly compared by Delong test.P<0.05 was considered a statistically significant difference.Results:There was good agreement of inter-reader evaluation(Fleiss Kappa value=0.718,95%CI:0.717-0.720,P<0.05).The degree of enhancement was positively correlated with Ktrans(r=0.933,P<0.05).There was no significant difference in the values of Kep、Ve、Vp、f and D*values in identifying synovial thickening(P>0.05).The Ktranscorrelated with ADC values and D values[r=-0.395(95%CI:-0.532--0.212),r=-0.489(95%CI:-0.609--0.342),respectively,P<0.05].The AUC value of D*(0.793,95%CI:0.712-0.873)was significantly higher than that of ADC(0.706,95%CI:0.602-0.810,P<0.05).Conclusions:IVIM MRI can be used to detect rheumat

关 键 词：类风湿性关节炎 滑膜炎 体素内不相干运动 磁共振成像 腕关节 

分 类 号：R445.2[医药卫生—影像医学与核医学] R686.7[医药卫生—诊断学]