T2WI-Dixon序列在杜氏肌营养不良症患者肌肉脂肪浸润和水肿评价中的应用价值研究  

Application value of T2WI-Dixon water fat separation sequence in the evaluation of muscle fat infiltration and edema in patient with Duchenne muscular dystrophy

作　　者：石采灵 傅航 郭应坤[2] 蔡晓唐[3] 许华燕 岳文军[1] SHI Cailing;FU Hang;GUO Yingkun;CAI Xiaotang;XU Huayan;YUE Wenjun*(Department of Radiology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education,Department of Radiology,West China Second Hospital,Sichuan University,Chengdu 610041,China;Key Laboratory of Urban Defects and Related Women and Children's Diseases of Ministry of Education,Department of Pediatric Neurology,West China Second Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]川北医学院附属医院放射科,南充637000 [2]四川大学华西第二医院放射科,出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [3]四川大学华西第二医院儿童神经科,出生缺陷与相关妇儿疾病教育部重点实验室,成都610041*

出　　处：《磁共振成像》2022年第7期96-102,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金(编号:81901712)。

摘　　要：目的对比T2加权水脂分离成像(T2WI-Dixon)序列与常规序列[T1WI和T2WI-SPAIR(spectral attenuated inversion recovery)序列]的图像质量以及在评价杜氏肌营养不良症(Duchenne muscular dystrophy,DMD)患者臀腿肌肉脂肪浸润和水肿程度中的一致性,探讨T2WI-Dixon作为单个序列在DMD患者臀腿部肌肉评估中的应用价值。材料与方法前瞻性纳入71例DMD患者进行3.0 T磁共振臀部及大腿轴位扫描,扫描序列包括T2WI-Dixon序列、T1WI序列和T2WI-SPAIR序列。采用主观(Likert 4分量表,内容包括图像伪影、脂肪抑制能力以及整体质量)与客观[定量测定图像信噪比(signal-noise ratio,SNR)与对比噪声比(contrast-to-noise ratio,CNR)]相结合的方法对各序列采集的图像质量进行综合评价。参考Mercuri分级量表和Kim分级量表对肌肉脂肪浸润和水肿程度进行评分,评估方法间的一致性。同时评估观察者间和观察者内主观评分一致性。结果在图像质量主观评价方面,T2WI-Dixon-fat的伪影和整体图像质量评分均高于T1WI(P均<0.001);T2WI-Dixon-water图像的脂肪抑制均匀性、伪影和整体图像质量评分也均高于T2WI-SPAIR(P均<0.001)。客观评价方面T2WI-Dixon-fat的CNR明显高于T1WI,而SNR明显低于T1WI(P均<0.001);T2WI-Dixon-water的SNR和CNR均高于T2WI-SPAIR(P均<0.001)。T2WI-Dixon-fat与T1WI在评价肌肉脂肪浸润程度时具有极好的一致性(Kappa=0.95,P<0.001);T2WI-Dixon-water与T2WI-SPAIR在评价肌肉水肿程度方面也具有极好的一致性(Kappa=0.84,P<0.001)。观察者内和观察者间主观评分具有中等至极好的一致性(Kappa值0.42~0.86,P均<0.001)。结论T2WI-Dixon序列对肌肉脂肪浸润和水肿程度的评估与常规序列具有较好的一致性,且能显著缩短扫描时间,提高图像质量,在评价DMD患者臀腿部肌肉损伤中具有很好的应用价值。Objective:This study aimed to compare image quality of T2-weighted imaging water-fat separation(T2WI-Dixon)sequence with conventional sequence[T1WI and T2WI-SPAIR(spectral attenuated inversion recovery)sequence]and the consistency in evaluating the degree of fatty infiltration and edema in the gluteal and leg muscles of patient with Duchenne muscular dystrophy(DMD),and to investigate the value of T2WI-Dixon as a single sequence in assessing the gluteal and leg muscles of patient with DMD.Materials and Methods:A total of 71 patient with DMD were prospectively enrolled for 3.0 T magnetic resonance imaging scanning of the hip and thigh.The scanning sequences included T2WI-Dixon fast spin echo sequence,T1WI sequence and T2WI-SPAIR sequence.The image quality of each sequence was comprehensively evaluated by combining subjective(Likert 4-point scale,including image artifacts,fat suppression ability,and overall quality)with objective[quantitative measurement of image SNR(signal-noise ratio)and CNR(contrast-to-noise ratio)]methods.The degree of muscle fatty infiltration and edema were scored using the Mercuri grading scale and the Kim grading scale to assess consistency between methods.Inter-observer and intra-observer subjective score consistency were also assessed.Results:In terms of subjective evaluation of image quality,the artifact and overall image quality score of T2WI-Dixon-fat were higher than those of T1WI(P<0.001).The fat suppression uniformity,artifact and overall image quality scores of T2WI-Dixon-water images were also higher than those of T2WI-SPAIR images(P<0.001).In objective evaluation,CNR of T2WI-Dixon-fat images were significantly higher than that of T1WI,while SNR were significantly lower than that of T1WI(P<0.001).SNR and CNR of T2WI-Dixon-water images were higher than those of T2WI-SPAIR(P<0.001).T2WI-Dixon-fat showed excellent consistency with T1WI in evaluating the degree of muscle fat infiltration(Kappa=0.95,P<0.001).T2WI-Dixon-water and T2WI-SPAIR also had excellent consistency in evaluating th

关 键 词：磁共振成像 水脂分离成像 杜氏肌营养不良 脂肪浸润 水肿 图像质量 

分 类 号：R445.2[医药卫生—影像医学与核医学] R746.2[医药卫生—诊断学]