摘要
目的通过与常规MRI及临床表现的对比观察,探讨动态增强MRI在幼年特发性关节炎髋关节股骨头骨髓水肿评估中的应用价值,获得检测骨髓水肿的敏感量化指标。方法收集确诊为JIA的患儿9例作为病例组,收集10例因其它疾病进行盆腔或髋关节增强MRI的患儿作为对照组。收集患儿的动态增强(DCE)MRI参数、常规MRI、临床表现及红细胞沉降率(ESR)、C反应蛋白(CRP)检测结果,其中DCE数据包括冠状位股骨头最大单层面和股骨头容积测量数据,具体为最大强化率(ME%),强化峰值时间(TTP)和血流量(BF)。为避免年龄等因素的干扰,本组对以上数据进行转换,选择同一患儿双侧髋关节各参数的差异率进行分析。最大单层面参数以下角标max表示,股骨头容积参数以下角标vol表示。采用两独立样本t检验比较病例组与对照组间DCE-MRI各参数的差异;并对常规MRI双侧股骨头骨髓信号无异常病例,根据临床有无4字征进行分组,探讨组间DCE-MRI各参数的差异;此外,对DCE参数与炎性指标的相关性进行分析。结果病例组与对照组DCE参数比较,两组间股骨头最大单层面的MEmax(t=4.805,P<0.001)和股骨头容积TTPvol(t=2.785,P=0.011)、BFvol(t=3.885,P=0.001)存在显著性差异。常规MRI双侧股骨头骨髓信号无异常病例中,4字征阳性组和阴性组比较,组间MEmax(t=3.049,P=0.007)和BFvol(t=2.089,P=0.041)具有统计学差异。实验室数据的相关分析显示ESR与DCE-MRI中的MEmax(相关系数r=0.532,P=0.016)具有显著相关性。结论DCE-MRI能够较常规MRI更为早期敏感地检测到JIA受累关节的骨髓水肿情况,尤其股骨头MEmax和BFvol在检测过程中最为敏感,比临床查体及实验室检查更加精准。
Objective To assess the feasibility of using dynamic contrast enhanced MRI(DCE-MRI)of bone marrow edema in juvenile idiopathic arthritis(JIA)patients,to compare it with conventional MRI and clinical assessment.Methods The hip joints of 9 patients with JIA and 10 patients as control group were studied.The conventional MRI,DCE-MRI,clinical Patrick sign and ESR/CRP were collected.Patients were classified into different groups according to conventional MRI and clinical Patrick sign different manifestations.The femoral head was observed,including coronal maximal single plane and volume parameters.Statistical measures of maximal enhancement(ME%)of maximal single plane,time-to-peak(TTP),Blood Flow(BF)of both single plane and volume were calculated between different groups.The relationship between DCE-MRI and CRP/ESR was analyzed with correlation analysis.Results There was statistically significant difference in MEmax(t=4.805,P<0.001),TTPvol(t=2.785,P=0.011)and BFvol(t=3.885,P=0.001)between case and control groups.Inthe cases with normal conventional MRI and different patrick sign manifestations,the difference of MEmax(t=3.049,P=0.007)and BFvol(t=2.089,P=0.041)was statistically significant.There was positive relationship between MEmax and ESR(r=0.532,P=0.016),other DCE-MRI findings had no significant relationship with ESR or CRP.Conclusion DCE-MRI is more sensitive in detecting bone marrow edema of JIA at an earlier stage than conventional MRI,especially the MEmax and BFvol,which is more accurate than clinical physical assessment and laboratory examination,and may be a more sensitive marker of inflammatory activity.
作者
杨洋
袁新宇
闫淯淳
白振华
赖建铭
YANG Yang;YUAN Xinyu;YAN Yuchun;BAI Zhenhua;LAI Jianming(Department of Radiology,Children's Hospital Affiliated to the Capital Institute of Pediatrics,Beijing 100020,P.R.China;Department of Rheumatism and Immunology,Children's Hospital Affiliated to the Capital Institute of Pediatrics,Beijing 100020,P.R.China)
出处
《医学影像学杂志》
2019年第12期2110-2114,共5页
Journal of Medical Imaging
基金
北京市医院管理局青年人才培养“青苗”计划项目(编号:QML20161302)
关键词
幼年特发性关节炎
髋关节
磁共振成像
动态增强
Juvenile idiopathic arthritis
Hip joint
Magnetic resonance imaging
Dynamic contrast-enhanced
