多参数MRI预测弥漫型IgG4相关眼眶病疗效的初步研究  

The preliminary study of multiparameters MRI in predicting the efficacy of diffuse IgG4-related orbital disease

作　　者：云雨婷 王永哲[2] 王紫仪 柳睿 马建民 杨本涛[2] YUN Yu-ting;WANG Yong-zhe;WANG Zi-yi(Department of Radiology,Civil Aviation General Hospital,Beijing 100123,China)

机构地区：[1]民航总医院放射科,北京100123 [2]首都医科大学附属北京同仁医院放射科,北京100730 [3]首都医科大学附属北京同仁医院眼科,北京100730 [4]首都医科大学大兴教学医院放射科,北京102600

出　　处：《放射学实践》2024年第3期347-352,共6页Radiologic Practice

基　　金：北京市医院管理中心“登峰”计划专项(DFL20190203);北京市医管局临床医学“扬帆”计划发展专项(ZYLX201704)。

摘　　要：目的:探讨多参数MRI指标在评估弥漫型IgG4相关眼眶病预后中的价值。方法:回顾性分析2012年1月-2020年12月首都医科大学附属北京同仁医院85例确诊为弥漫型IgG4相关眼眶病患者的眼眶MRI,其中40例行DWI检查。患者经过规律随访(中位时间3.5年),根据随访结果将患者分为复发组和未复发组,比较两组间眼外肌受累数、颅神经分支受累数(额神经、眶下神经、上颌神经、翼管神经、腭大神经、下颌神经、鼻睫神经)、脑膜受累情况、受累泪腺、眼外肌、神经的ADC值及ADC-R,以及眶内实性病变ADC值整体直方图的各项参数,分析以上影像学指标在评估患者预后中的价值。计数资料采用卡方分析或Fisher精确检验,计量资料采用非参数检验(Mann-Whitney U检验),以P<0.05为差异具有统计学意义。采用受试者操作特征(ROC)曲线分析对上述有意义的参数进行分析并评价其预测价值。结果:比较复发组和未复发组间的各项影像指标,差异具有统计学意义的指标如下:脑膜受累(χ^(2)=6.143,P=0.013)ROC曲线下面积(AUC)为0.623,敏感度40.4%,特异度84.2%;颅神经分支受累数(U=535,P=0.001)AUC为0.700,敏感度46.8%,特异度92.1%;ADC-R神经(U=5,P=0.026)临界值1.187,AUC为0.848,敏感度100%,特异度81.8%;ADC_(10%)(U=118,P=0.034)临界值0.903×10^(-3)mm^(2)/s,AUC为0.698,敏感度58.8%,特异度91.3%。脑膜受累、颅神经分支受累数越多、低ADC-R神经及低ADC_(10%)表明患者易复发。结论:颅神经分支(额神经、眶下神经、上颌神经、翼管神经、腭大神经、下颌神经、鼻睫神经)受累数、脑膜受累、ADC-R神经、ADC_(10%)对预测弥漫型IgG4相关眼眶病的复发具有提示价值。Objective:To investigate the value of imaging parameters of diffuse IgG4-related orbital disease in assessing the prognosis of this disease.Methods:The orbital MRI of 85 patients diagnosed with diffuse IgG4-related orbital disease from January 2012 to December 2020 at Beijing Tongren Hospital,Capital Medical University,were retrospectively analyzed,40 of whom were examined by DWI.After regular follow-up(median time 3.5 years),the patients were divided into relapse and non-relapse groups based on the results of the follow-up.The differences in general clinical data and imaging signs were compared between the two groups.The involved structures included the extraocular muscles,cranial nerve branches(frontal nerve,infraorbital nerve,maxillary nerve,pterygoid nerve,palpebral nerve,mandibular nerve,and nasociliary nerve),and the meninges.The ADC values and ADC-R of the involved lacrimal gland,extraocular muscles,and cranial nerve branches between the two groups were compared.The ADC histogram parameters were also compared between the two groups.The cardinality analysis or Fisher's exact test was used for count data,and nonparametric test(Mann-Whitney U test)was used for measurement data in this study.P value<0.05 was considered to have a significant difference.The ROC curve analysis method was applied to analyze the above significant parameters and evaluated their predictive value.Results:Between the relapse and non-relapse groups,the imaging indicators showing statistically significant differences were as follows:meningeal involvement(χ^(2)=6.143,P=0.013),AUC of 0.623,sensitivity 40.4%,specificity 84.2%;the number of cranial nerve branches involved(U=535,P=0.001),AUC of 0.700,sensitivity 46.8%,specificity 92.1%;ADC-R nerve(U=5,P=0.026),critical value 1.187,AUC of 0.848,sensitivity 100%,specificity 81.8%;ADC_(10%)(U=118,P=0.034),critical value 0.903×10^(-3)mm^(2)/s,AUC of 0.698 sensitivity 58.8%,specificity 91.3%.The higher number of nerve involvement,meningeal involvement,low ADC-R nerve and low ADC_(10%)indicated t

关 键 词：IgG4相关眼眶病 磁共振成像 扩散加权成像 ADC直方图 

分 类 号：R445.2[医药卫生—影像医学与核医学] R593.2[医药卫生—诊断学]