膝关节MRI替代X线检查评估骨骺发育推断骨龄的可行性研究  

The feasibility study of knee MRI instead of X-ray in assessing epiphyseal development for bone age estimation

作　　者：邓小冬[1] 成子琦 林雨山 范飞[2] 占梦军 王廷宏 向明亮 张伟[1] 刘云[1] 邓振华[2] DENG Xiao-dong;CHENG Zi-qi;LIN Yu-shan;FAN Fei;ZHAN Meng-jun;WANG Ting-hong;XIANG Ming-liang;ZHANG Wei;LIU Yun;DENG Zhen-hua(Institute of Basic Medical Sciences&Forensic Medicine,North Sichuan Medical College,Nanchong 637000;School of Basic Medical Sciences&Forensic Medicine,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]川北医学院基础医学与法医学研究所,四川南充637000 [2]四川大学基础医学与法医学院,四川成都610041

出　　处：《川北医学院学报》2023年第7期883-888,共6页Journal of North Sichuan Medical College

基　　金：四川省自然科学基金项目(2022NSFSC1286);四川省重点研发项目面上项目(2022YFS0530);证据科学教育部重点实验室(中国政法大学)开放基金资助课题(2021KFKT03);四川省博士后科研项目特别资助项目(2021-12);南充市市校科技战略合作专项(22SXQT0177)。

摘　　要：目的:探讨膝关节MRI替代X线片评估膝关节骨骺发育推断骨龄的可行性。方法:采用《法庭科学汉族青少年骨龄鉴定技术规程》和Schmeling与Kellinghaus联合分级法回顾性分析123例11~25岁中国汉族青少年3.0 T膝关节矢状位T1-TSE序列MRI和X线片股骨远端骨骺、胫骨近端骨骺发育等级,分析膝关节MRI替代X线片评估膝关节骨骺发育的一致性、可靠性及重复性。绘制受试者工作特征(ROC)曲线,根据曲线下面积(AUC)评估膝关节MRI与X线片骨骺发育等级判别18岁年龄节点的判别能力。结果:MRI与X线片股骨远端骨骺、胫骨近端骨骺发育等级的一致性较好(Kappa=0.926~1.000),等级间差异无统计学意义(P>0.05);MRI股骨远端骨骺、胫骨近端骨骺发育等级的可靠性及重复性较好(Kappa=0.904~0.975),优于X线片(Kappa=0.894~0.950)。MRI股骨远端骨骺、胫骨近端骨骺发育等级与年龄相关性较强(r=0.714~0.775),与X线片表现相当(r=0.714~0.767)。ROC曲线显示,MRI与X线片股骨远端、胫骨近端骨骺发育等级均具备较强的18岁年龄节点判别能力(AUC=0.850~0.900),MRI股骨远端骨骺的判别表现优于X线片。结论:膝关节MRI可替代X线片评估骨骺发育等级推断青少年骨龄。Objective:To explore the feasibility of knee MRI instead of X-rays in assessing epiphyseal development for bone age estimation.Methods:The grades of distal femoral and proximal tibial epiphysis based on sagittal T1-TSE sequence of 3.0 T knee MRI and knee X-rays from 123 Chinese Han adolescents aged 11~25 years were retrospectively assessed by the《Technical Regulations for Bone Age Assessment of Han Adolescents in Forensic Science》(GA/T 1583-2019),Schmeling and Kellinghaus joint grading method.The consistency,reliability and repeatability of grades of distal femoral epiphysis and proximal tibial epiphysis based on knee MRI instead of X-rays images were evaluated.Receiver operating characteristic(ROC)curves were plotted,and the ability to distinguish 18-year old by MRI and X-ray epiphysis was evaluated according to the Area Under Curve(AUC).Results:There was strong consistency on the grades of distal femoral epiphysis or proximal tibial epiphysis between knee MRI and X-rays images(Kappa=0.926~1.000).The significant difference of the grades of distal femoral epiphysis or proximal tibial epiphysis were not founded(P>0.05).The intra-observer and inter-observer of Kappa values(0.904~0.975)for evaluating the grades of distal femoral epiphysis and proximal tibial epiphysis based on knee MRI by epiphysis grading method were better than X-rays(0.894~0.950).The grades of distal femoral epiphysis and proximal tibial epiphysis based on knee MRI were positively correlated with age(r=0.714~0.775)correspond to X-rays(r=0.714~0.767).ROC curve showed that MRI and X-rays had a strong ability to distinguish 18 years old(AUC=0.850~0.900),and the identification performance of distal femur epiphysis of MRI was better than X-rays.Conclusion:Knee MRI is likely to substitute X-rays for evaluating the grade of knee epiphysis to estimate bone age.

关 键 词：法医影像学 骨龄 核磁共振成像 膝关节 骨骺 

分 类 号：R445.1[医药卫生—影像医学与核医学]