DCE-MRI与DWI对类风湿性关节炎活动性诊断价值的研究

The value of DCE-MRI and DWI in the diagnosis of rheumatoid arthritis activity

目的探讨动态增强磁共振成像(DCE-MRI)与扩散加权成像(DWI)用于类风湿性关节炎(RA)活动性的诊断价值。方法采用前瞻性研究方法,纳入28例临床确诊的RA患者,活动组18例,稳定组10例,所有病例均行双腕关节MRI常规扫描、DWI和DCE-MRI检查,分析病变的表观扩散系数(ADC)、DCE-MRI的时间-信号强度曲线(TIC)、早期强化率(EER)、平均强化率(AER)及最大强化率(MER)、达峰时间(TTP);采用秩和检验评价两组间量化参数的差异性,运用Spearman相关分析评价DWI和DCE-MRI的量化参数及临床疾病活动性评分DAS28的相关性,用ROC曲线下面积评价DWI和DCE-MRI的量化参数对RA活动性的诊断效能。结果活动组及稳定组RA间的DWI和DCE-MRI的量化参数差异性有统计学意义(P均<0.05)。ADC值和EER、AER、MER、DAS28呈负相关,与TTP呈正相关;EER、AER、MER与DAS28呈正相关,TTP与DAS28呈负相关。ADC值和EER、AER、MER及TTP的ROC曲线下面积分别为0.964、0.972、0.797、0.944、0.944,均有诊断效能。结论 DCE-MRI与DWI可以从血流动力学及水分子弥散受限两方面对RA活动性进行双重量化,诊断效能较高,值得推荐;而对于不能耐受造影剂的患者可考虑单独采用DWI扫描,亦具有较好的诊断价值。

Objective To investigate the clinical value of dynamic contrast-enhanced MRI （ DCE-MRI） and diffusion weigh-ted imaging （ DWI） in the diagnosis of Rheumatoid Arthritis Activity. Methods Twanty-eight patients with RA were enrolled in-to the study by using the prospective study method,18 cases were in the active group, 15 cases were in the stable group. All the patients underwent conventional MRI , DCE-MRI and DWI. The time intensity curve（ TIC） and ADC were analyzed. The early enhancement rate （ EER） , the average enhancement rate （ AER） and maximum enhancement ratio （ MER） , time to peak （ TTP） were measured on DCE-MRI. The differences of quantitative parameters and ADC values between the two groups were evaluated by rank sum test. The correlations between quantitative parameters of DCE-MRI and ADC values and DAS28 were evaluated by Spearman correlation analysis. The ROC curve analysis was used to test the diagnostic power of quantitative parameters and ADC values. Results The quantitative parameters of DCE-MRI and DWI were significantly different between activity group and stable group （ P 〈0. 05）. ADC values and EER, AER, MER, DAS28 were negatively correlated. ADC values and TTP was positively correlated. DAS28 and EER, AER, MER were negatively correlated. DAS28 and TTP was positively correlated. The biggest area under the ROC curve of DCE-MRI quantitative parameters and ADC values was 0. 964, 0. 972, 0. 797, 0. 944, 0. 944, all of which had the diagnostic efficacies. Conclusion DCE-MRI and DWI could be used for differential diagnosis of activity of RA. The combined using of DCE-MRI and DWI could quantitative differentiate activity of RA from two aspects of hemodynamic and wa-ter molecules diffusion, which was worth recommending. DWI could be specifically used for the patients who could not tolerate contrast agent.