DWI、DCE-MRI诊断骶髂关节急性炎症的价值

Application of DWI and DCE-MRI in the diagnosis of acute sacroiliitis

目的:探讨DWI、DCE-MRI诊断骶髂关节(SIJ)急性炎症的价值。方法:选取42例骶髂关节炎患者及18例志愿者(对照组),对所有60例受检者行双侧骶髂关节MR平扫、动态增强MRI(DCE-MRI)及扩散加权成像(DWI)检查。根据TIRM-T2WI序列上骨髓信号是否增高将42例患者分为急性炎症组(18例)和非急性炎症组(24例)。对急性炎症组患者进行SPARCC评分。描绘时间-信号曲线(TIC)并对其进行分型;计算、测量各组骨髓区的增强因子(Fenh)、增强斜率(Senh)及表观扩散系数(ADC)值。并对急性炎症组患者的SPARCC评分、ADC值及Fenh三者间进行相关性分析。结果:急性炎症组SPARCC评分为(21.06±7.20)分。TIRM-T2WI、DWI及DCE-MRI分别检出35、34、36侧关节面下急性炎症,三者间检测能力差异无统计学意义(χ2=2.06,P>0.05)。急性炎症组病变区ADC值、Fenh及Senh均高于非急性炎症组、对照组,差异均有统计学意义(F值分别为381.591、62.080、11.097,P值均<0.01);非急性炎症组与对照组上述三个参数间差异无统计学意义(P值均>0.05)。急性炎症组TIC表现为快速上升平台型(72.22%)和持续快速上升型(27.78%);非急性炎症组和对照组TIC均表现为速升缓降型。急性炎症组的SPARCC评分与ADC值、SPARCC评分与Fenh、ADC值与Fenh均呈正相关(r值分别为0.874、0.673、0.723,P值均<0.05)。结论:DWI、DCE-MRI检出SIJ急性炎症的能力相当;通过计算ADC值、Fenh及Senh可对炎性病变程度进行量化评价,DWI、DCE-MRI对SIJ急性炎症的诊断具有重要价值。

Objective：To investigate the value of diffusion-weighted imaging（DWI）and dynamic contrast-enhanced MRI（DCE-MRI）in the diagnosis of acute sacroiliitis（AI）.Methods：A total of 42 patients with typical clinical symptoms of sacroiliitis,as well as 18 healthy volunteers（control group）were enrolled.Bilateral sacroiliac joints were examined by plain MR scanning,DCE-MRI and DWI.According to whether the marrow signal became hyperintense on TIRM-T2 WI,42patients were divided into acute inflammation group（18patients）and non-acute inflammation group（24patients）.SPARCC score were measured in the acute inflammation group.Time-intensity curve（TIC）was obtained on DCE-MRI and classified.The factor of enhancement（Fenh）,slope of enhancement（Senh）and ADC value of the marrow area in different groups were calculated and measured.Correlative analysis was performed among SPARCC score,ADC value and Fenh in the acute inflammation group.Results：The SPARCC score in the acute inflammation group were 21.06±7.20.TIRM-T2 WI,DWI and DCE-MRI displayed 35,34,36 sides respectively with acute inflammation below the joint facet,with no significant difference in the detection of AI（χ2=2.06,P〉0.05）.The mean ADC values,Fenh,Senh in the acute inflammation group were higher than those in the non-acute inflammation group and control group,with significant difference（F=381.591,62.080,11.097respectively;all P〈0.01）.The above-mentioned three parameters showed no significant statistic difference between the non-acute inflammation group and control group（all P〉0.05）.The TIC of acute inflammation group shown fast arisingplateau pattern in 13patients（72.22%）,persistent fast arising pattern in 5patients（27.78%）.All of the TIC in non-acute inflammation group and control group shown fast arising and slow descending pattern.The Spearman correlation analysis showed positive correlation in SPARCC score and ADC value,SPARCC score and Fenh,ADC value and Fenh in acute inflammation group（r=0.874,0.673,0.723respectively;all P〈0.05）.Conclusion：There was no significant difference of DWI and DCE-MRI in detecting acute sacroiliitis.The ADC values,Fenh and Senh can be effectively used to quantify inflammatory areas in SI joints.DWI and DCE-MRI had a significant clinical value in detecting acute sacroiliitis.