股骨头坏死磁共振灌注参数与ARCO分期的相关性

Correlation of MRI Perfusion Parameters with the ARCO Stage of Femoral Head Necrosis

目的探讨股骨头坏死(ANFH)不同病变阶段的MR灌注特征,分析初始时间-浓度曲线下面积(iAUC)、转运常数(K^(trans))与国际骨循环研究会(ARCO)分期的相关性。资料与方法前瞻性纳入20例健康志愿者(对照组)及45例ANFH初治患者,行MR灌注加权成像(PWI)检查和ARCO分期评估,比较对照组与ANFH组ARCO I期、II期、III期、IV期的iAUC值和K^(trans)值,分析ARCO分期与iAUC、K^(trans)值的相关性。结果 ANFH组83侧股骨头中,I期18侧,II期20侧,III期21侧,IV期24侧。对照组、I期、II期、III期、IV期的i AUC值比较差异有统计学意义(F=77.520,P<0.001),除I期与IV期差异无统计学意义(P>0.05)外,其余两两比较差异均有统计学意义(P<0.05)。对照组、I期、II期、III期、IV期的K^(trans)值比较差异有统计学意义(F=23.935,P<0.001),对照组K^(trans)值与I期、II期、III期、IV期比较差异有统计学意义(P<0.001)。对照组、I期、II期、III期、IV期与i AUC值、K^(trans)值呈正相关(r=0.612、0.557,P<0.001),其中对照组、I期、II期、III期与i AUC值、K^(trans)值呈显著正相关(r=0.906、0.854,P<0.01)。结论 PWI可以评估ANFH不同病程阶段的灌注特征,且i AUC、K^(trans)值与ARCO分期有较高的相关性,是反映ANFH不同病变阶段血流灌注的重要指标,可为ANFH血流动力学的临床研究提供影像学依据。

Purpose To evaluate the MR perfusion weighted imaging（MR PWI）characteristics of avascular necrosis of the femoral head（ANFH） at different association research circulation osseous（ARCO） stages, and to analyze the potential correlation of initial area under the time-concentration curve（iAUC）, transfer rate constant（K^（trans）） with the ARCO stage of ANFH. Materials and Methods Twenty normal volunteers（control group） and forty-five newly diagnosed ANFH patients undergoing PWI examination and ARCO stage assessment. The differences of MR perfusion parameters（i AUC, K^（trans）） between the two groups and among patients with different ARCO stages（I, II, III, IV） were compared, and the correlations between MR perfusion parameters and ARCO stage were analyzed. Results In all 83 femoral heads with ANFH, there were 18 in stage I, 20 in stage II, 21 in stage III, 24 in stage IV. There were significant differences with control group and among stage I, II, III and IV（F=77.520, P〈0.001） lesions. The i AUC values of control group, stage I, II, III and IV were statistically different（P〈0.05）, except stage I and IV（P〈0.05）. There were significant differences on control group, stage I, II, III and IV（F=23.935, P0.001）. The K^（trans） were significantly different with control group and among stage I, II, III and IV（P〈0.001）. The values of i AUC and K^（trans） showed positive correlation with control group, stage I, II, III and IV（r=0.612 and 0.557, P〈0.001）, and the values of i AUC and K^（trans） showed significant positive correlation with control group, stage I, II and III（r=0.906 and 0.854, P〈0.001）. Conclusion PWI can provide significant perfusion characteristics for ARCO staging. K^（trans） and i AUC are correlated with ARCO stage, which is an important index to reflect the blood perfusion of different stages of ANFH. These provide a reference for the clinical study of ANFH hemodynamics.