摘要
目的探讨MR弥散加权成像(DWI)及其表观弥散系数(ADC)值在强直性脊柱炎(AS)患者骶髂关节面下骨髓水肿的解剖位置分布及定量分析中的应用价值。方法前瞻性非随机对照研究。纳入2021年1月—12月贵州医科大学附属医院风湿免疫科AS患者35例为AS组,其中男22例、女13例,年龄16~44(28.0±7.2)岁。招募年龄与AS组相匹配、性别构成大致均衡的正常志愿者30例为对照组,其中男14例、女16例,年龄20~45(26.9±6.2)岁。2组研究对象均接受斜冠状位和轴位的短时反转恢复(STIR)-T2加权成像(T2WI)及T1加权成像(T1WI)等4个常规序列的MR扫描,以及斜冠状位DWI序列扫描;对AS组患者骶髂关节进行MRI分级评估,并根据其DWI图上是否出现高信号将AS组分为AS骨髓水肿明显组(19例)和AS骨髓水肿不明显组(16例),观察AS骨髓水肿明显组患者骨髓水肿在骶髂两端关节软骨下的分布。采用ADW 4.7后处理工作站自带的Functool软件测量AS组和对照组左右两侧骶髂关节面下的骶端、髂端软骨下骨髓ADC值,比较AS组与对照组ADC值,比较AS组骶、髂端及不同分级ADC值。结果AS组与对照组的性别、年龄比较差异均无统计学意义(P值均>0.05)。35例AS患者MRI分级Ⅰ级7例,Ⅱ级17例,Ⅲ级6例,Ⅳ级5例。AS骨髓水肿明显组19例中Ⅰ级4例(3例累及髂端、1例累及骶髂两端),Ⅱ级10例(9例累及骶髂两端、1例累及骶端),Ⅲ级4例和Ⅳ级1例均累及骶髂两端。AS组左侧骶、髂两端和右侧的骶、髂两端骨髓ADC值分别为(4.94±1.90)×10^(-4)mm^(2)/s、(4.84±2.21)×10^(-4)mm^(2)/s和(4.38±1.86)×10^(-4)mm^(2)/s、(4.23±1.64)×10^(-4)mm^(2)/s,均高于对照组相应端侧的骨髓ADC值(3.45±1.44)×10^(-4)mm^(2)/s、(3.48±1.25)×10^(-4)mm^(2)/s、(3.28±1.35)×10^(-4)mm^(2)/s、(3.08±1.37)×10^(-4)mm^(2)/s,差异均有统计学意义(P值均<0.05)。AS骨髓水肿明显者19例骨髓水肿区域的ADC值为(4.85±1.44)×10^(-4)mm^(2)/s,AS骨髓水肿不明显组16例左右两侧骶髂两端关节面下骨髓总体ADC值为(4.30±0.64)×10^(-4)mm^(2)/s,均高于对照组的(3.32±1.36)×10^(-4)mm^(2)/s,差异有统计学意义(F=9.27,P<0.001)。结论DWI的ADC值可对AS骶髂关节面下骨髓水肿进行定量分析,显示AS不同MRI分级患者骶髂关节面下骨髓水肿的发生部位及严重程度,且对尚未出现明显信号改变的骨髓水肿具有一定诊断价值。
Objective This study aimed to discuss the value of apparent diffusion coefficient(ADC)based on diffusion-weighted imaging(DWI)in the anatomical location and quantitative analysis of bone marrow edema in the sacroiliac joint in ankylosing spondylitis(AS).Methods This was a prospective non-randomized controlled study.A total of 35 AS patients from the Affiliated Hospital of Guizhou Medical University from January to December 2021 were included in the AS group,including 22 males and 13 females,aged 16-44(28.0±7.2)years old.Meanwhile,a total of 30 normal volunteers matching the age of the AS group with a roughly balanced gender composition were recruited as the normal control group,including 14 males and 16 females,aged 20-45(26.9±6.2)years old.All the participants underwent oblique coronal short time inversion recovery(STIR)-T2WI,oblique coronal T1WI,axial STIR-T2WI,axial T1WI,and oblique coronal DWI sequences.The images of patients'sacroiliac joints were analyzed and graded based on the MRI grade system.The AS group was divided into the obvious bone marrow edema group(19 patients)and the insignificant bone marrow edema group(16 patients)depending on if there were high signals on the DWI images.The site of occurrence of bone marrow edema in the obvious bone marrow edema group was statistically analyzed.The ADC values of subchondral bone marrow(bilateral sacral and iliac sides)in AS and normal control groups were measured using the self-contained Functool software equipped on the GE healthcare MR post-processed workstation ADW 4.7.A two-sample t-test was used to compare the ADC values of AS and normal control groups.The paired sample t-test was used to compare ADC values of the sacral and iliac sides of different grades of patients in the AS group.Results No significant difference was observed in gender and age between the two groups(all P values>0.05).The MRI grading of 35 AS patients included 7,17,6,and 5 patients of gradesⅠ,Ⅱ,Ⅲ,andⅣ,respectively.In the obvious bone marrow edema group of AS,there were three patients of gradeⅠinvolved only the iliac side,and one patient involved both the sacral and iliac sides.Of the 10 patients of gradeⅡ,9 patients involved both sacral and iliac sides.In addition,four patients of gradeⅢinvolved sacral and iliac sides.Moreover,bone marrow edema was obvious in one patient of gradeⅣ,involving both the sacral and iliac sides.The ADC values of bone marrow in the AS group were as follows:(4.94±1.90)×10^(-4)mm^(2)/s at the left sacral side,(4.84±2.21)×10^(-4)mm^(2)/s at the left iliac side,(4.38±1.86)×10^(-4)mm^(2)/s at the right sacral side,(4.23±1.64)×10^(-4)mm^(2)/s at the right iliac side.These ADC values were higher than those of the control group:at the left sacral side(3.45±1.44)×10^(-4)mm^(2)/s,at the left iliac side(3.48±1.25)×10^(-4)mm^(2)/s,at the right sacral side(3.28±1.35)×10^(-4)mm^(2)/s,and at the right iliac side(3.08±1.37)×10^(-4)mm^(2)/s,and significant differences were found(all P values<0.05).The ADC values of bone marrow in the obvious bone marrow edema group(4.85±1.44)×10^(-4)mm^(2)/s and(4.30±0.64)×10^(-4)mm^(2)/s in the insignificant bone marrow edema group were higher than those in the control group(3.32±1.36)×10^(-4)mm^(2)/s,and significant differences were observed(F=9.27,P<0.001).Conclusion ADC value of DWI can be used for quantitative analysis of bone marrow edema under the surface of the sacroiliac joint in AS,and can indicate the occurrence location and display the severity of bone marrow edema of the sacroiliac joint in AS patients with different MRI grades and has certain diagnostic value for bone marrow edema without obvious signal changes.
作者
宋玲玲
张紫微
王家维
曾琪
眭贺
李语
梁晨
黄曌殊
周石
Song Lingling;Zhang Ziwei;Wang Jiawei;Zeng Qi;Sui He;li Yu;Liang Chen;Huang Zhaoshu;Zhou Shi(Department of Radiology,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)
出处
《中华解剖与临床杂志》
2023年第8期512-518,共7页
Chinese Journal of Anatomy and Clinics
关键词
脊柱炎
强直性
骶髂关节
骨髓水肿
磁共振成像
扩散加权成像
表观扩散系数
Spondylitis,ankylosing
Sacroiliac joint
Bone marrow edema
Magnetic resonance imaging
Diffusion magnetic resonance imaging
Apparent diffusion coefficient value
