磁共振增强三维短时反转恢复变角激发T2WI快速自旋回波序列在成人精道解剖结构显示中的应用价值

The application of magnetic resonance enhanced 3D STIR T2WI SPACE sequence in the display of the anatomical structure of the seminal tracts in adults

目的探讨MR增强三维短时反转恢复变角激发T2加权成像(T2WI)快速自旋回波(3D STIR T2WI SPACE)序列对成人精道解剖结构显示的可行性及应用价值。方法回顾性研究。收集2016年11月—2019年3月复旦大学附属华东医院MR室58例成年男性腹盆腔MRI资料,年龄29~87岁,按年龄分为低龄组(≤60岁,22例)和高龄组(>60岁,36例)两组。所有患者均在德国西门子Syngo Via数据后处理工作站3D Viewer薄层最大强度投影(MIP)后行多平面重组(MPR)及曲面重组(CPR)。用3D Viewer行薄层MIP,获得冠状位、轴位、矢状位薄层MIP重建图。观察输精管壶腹段、后腹膜段和精囊腺的形态、走行、信号强度、背景抑制情况,参照日本Oh-Oka团队的评分标准,分别在MPR轴位和CPR图像对输精管壶腹段、后腹膜段和精囊腺进行图像质量评分。采用Wilcoxon符号秩检验对比分析MPR轴位与CPR图像分别在输精管壶腹段、后腹膜段和精囊腺的图像质量评分,Wilcoxon秩和检验对比分析低龄组和高龄组在CPR图像上的图像质量评分。统计前列腺小囊检出率,并在3D Viewer获得的冠状位、轴位、矢状位三个方位薄层MIP重建图上测量前列腺小囊三个方位的径线值。结果58例男性腰腿痛患者116侧输精管后腹膜段、壶腹段和精囊腺MR增强3D STIR T2WI SPACE序列MPR轴位和CPR图像质量评分分别为3(3,3)、2(2,2)、2(1,2)分和2(2,2)、2(1,2)、2(1,2)分,差异均有统计学意义(Z=10.232、5.196、2.000,P值均<0.05)。22例(44侧)低龄组和36例(72侧)高龄组腰腿痛患者输精管后腹膜段、壶腹段和精囊腺MR增强3D STIR T2WI SPACE序列CPR图像在的图像质量评分分别为2(1,2)、2(1,2)、1(1,2)分和2(2,2)、2(2,2)、2(1,2)分,组间比较差异均有统计学意义(Z=2.673、2.249、3.042,P值均<0.05)。58例患者前列腺小囊检出率为27.58%(16/58),前列腺小囊冠、横、矢三个方位径线值分别为5.35(4.33,6.88)、7.50(5.90,9.00)、8.00(6.43,10.78)mm。结论MR增强3D STIR T2WI SPACE序列能较清晰显示精囊腺、输精管壶腹段、后腹膜段以及前列腺小囊等精道精细结构解剖,可为指导临床提供影像学参考。

Objective To explore the feasibility and application value of magnetic resonance enhanced three dimensional T2WI turbo-spin-echo sequence with short-term inversion recovery and sampling perfection using different flip angle evolutions(3D STIR T2WI SPACE)sequence on the anatomical structure of seminal tracts in adults.Methods MRI data of 58 adult male patients in the MR room of Huadong Hospital affiliated to Fudan University from November 2016 to March 2019 were retrospectively collected,aged from 29 to 87 years,they were divided into younger age group(≤60 years old,22 cases)and the older group(>60 years old,36 cases).All patients underwent multiplanar reformation(MPR)and curved planar reformation(CPR)after the 3D Viewer thin-layer maximum intensity projection(MIP)of the Siemens Syngo Via data processing station in Germany.The three-dimensional MIP reconstruction maps of the coronal,transverse and sagittal planes were obtained using the 3D Viewer to perform thin layer MIP.The morphology,running detour,signal intensity and background inhibition of the ampulla of the vas deferens,the posterior peritoneal segment and the seminal vesicles,refer to the scores of the Oh-Oka team in Japan,and the ampulla of the vas deferens and the posterior peritoneum in the MPR axial position and CPR images were observed,respectively.Segment and seminal vesicles were scored for image quality.The Wilcoxon signed rank test was used to compare the image quality scores of the MPR axial position and CPR images in the ampulla of the vas deferens,the posterior peritoneum and the seminal vesicles.The independent Wilcoxon rank test for two independent samples was used to compare the image quality scores of CPR images in the young and old groups.The detection rate of prostate capsules was counted,and the diameters of the three small azimuths of the prostate,the transverse and the vector were measured by the 3D MIP reconstruction images obtained from the 3D Viewer.Results Among the 58 patients(116 sides),the image quality scores of the MPR axial and CPR images of the 3D STIR T2WI SPACE sequence in the peritoneal vas deferens,the vas deferens,and the seminal vesicles were 3(3,3)and 2(2,2),2(2,2)and 2(1,2),2(1,2)and 2(1,2)scores,respectively.The MPR axial position and CPR images were statistically different in the peritoneal segment of the vas deferens and the ampulla segment of the vas deferens(Z=10.232,5.196,2.000,all P values<0.05).The image quality scores of the CPR images of the posterior vas deferens,the vas deferens and the seminal vesicles in the 22 patients with low-grade and 36 elderly patients with low back pain were 2(1,2)and 2(2,2),2(1,2)and(2,2),1(1,2)and 2(1,2)scores,respectively.In the two age groups,the MR-enhanced 3D STIR T2WI SPACE sequence CPR images in the patients with lower back pain were statistically significant(Z=2.673,2.249,3.042,all P values<0.05)in the ampulla segment of the vas deferens and seminal vesicles.The 58 cases of abdominal pelvic magnetic resonance enhanced 3D STIR T2WI SPACE sequence of prostate utricle cysts detection rate of 27.58%(16/58),and prostate utricle cysts’size in coronal,transverse and sagittal planes were 5.35(4.33,6.88)mm,7.50(5.90,9.00)mm and 8.00(6.43,10.78)mm,respectively.Conclusions Magnetic resonance enhanced 3D STIR T2WI SPACE sequence can clearly show the seminal vesicles,vas deferens pelvic segment,posterior peritoneal segment and prostate utricle cysts.Fine structural anatomy can provide imaging reference for guiding clinical practice.