DWI联合磁化传递对比成像评估强直性脊柱炎骶髂关节病变活动性

DWI combined with magnetization transfer imaging in the diagnosis of sacroiliitis activity in ankylosing spondylitis

目的:探讨DWI联合磁化传递对比成像(MT)能否提高对强直性脊柱炎(AS)骶髂关节炎活动性的诊断价值。方法:按照纽约标准将39例临床诊断的AS患者分为活动组和非活动组,测量骨髓水肿区(BME)、硬化区(Sc)、脂肪沉积区(FD)、正常骨髓区(NABM)的ADC值和骶髂关节软骨的磁化传递率(MTRc)。采用独立样本t检验比较两组间5项参数值的差异,并采用ROC曲线分析各参数对骶髂关节炎活动性的诊断效能,将有预测价值的参数进行logistic回归联合,并采用ROC曲线分析回归方程对关节炎活动性的预测价值。结果:两组间ADCBME、ADCNABM和MTRc的差异有统计学意义(P=0.001,P<0.001和P=0.025);ADCBME、ADCNABM、MTRc、ADCBME+ADCNABM、ADCNABM+MTRc和ADCBME+MTRc的ROC曲线下面积(AUC)分别为0.738、0.849、0.719、0.885、0.849和0.864(P值均<0.05)。联合指标(ADCBME+MTRc和ADCNABM+MTRc)预测骶髂关节炎活动性的价值提高。结论:DWI和MT联合能提高诊断AS的能力和预测AS活动性。

Objective:The purpose was to explore the diagnostic value of diffusion-weighted imaging(DWI)combined with magnetization transfer(MT)imaging in the diagnosis of sacroiliitis activity in patients with ankylosing spondylitis(AS).Methods:39 patients with clinical diagnosed AS were collected and retrospectively analyzed between April 2017 and November 2017.All the patients were divided into active group and inactive group according to Ankylosing Spondylitis International Society(ASAS)diagnostic criteria,and underwent MRI scan with DWI and MT sequences at a 3.0T scanner.The magnetization transfer(MT)rate of the cartilage(MTRc)and ADC values of bone marrow edema(BME),sclerosis area,fat deposit area,and normal-appearing bone marrow(NABM)in the two groups were measured and compared by two independent samples t-test.Receiver-operating characte-ristics(ROC)curves and logisitic regression analysis were performed to determine the predictive value of DWI and MT alone and in combination for AS activity.Results:The ADCNABM,ADCBME and MTRc were statistically different between the two groups(P=0.001,<0.001 and 0.025,respectively).ADCBME,ADCNABM,MTRc,ADCBME+ADCNABM,ADCNABM+MTRc and ADCBME+MTRc could predict AS activity with the AUC of 0.738,0.849,0.719,0.885,0.849 and 0.864(all P<0.05).The diagnostic efficacy of ADCBME+MTRc and ADCNABM+MTRc was improved by the combination compared with each factor alone.Conclusion:The combination of DWI and MT might improve the diagnostic performance in AS and its activity.