动态对比增强MRI在骨科临床应用中的热点问题

Hot issues in clinical application of dynamic contrast-enhanced magnetic resonance imaging in orthopedics

背景:虽然传统平扫+增强磁MRI已被应用于骨骼肌肉成像多年,但不足以评估病变组织微观改变特征或病变组织活性,而动态对比增强MRI可捕捉该方面的信息,在骨科影像学检查中显示出优势。目的:综述动态对比增强MRI在骨科临床中的应用进展。方法:通过计算机在CNKI数据库、PubMed数据库、Web of Science及万方数据库检索1900年1月至2020年2月收录的相关文献,检索词为"动态对比增强磁共振成像;骨肌肿瘤;关节炎;脊柱;骨折;Dynamic contrast enhanced magnetic resonance imaging(DCE-MRI);osteomuscular tumor;arthritis;spinal surgery;fracture"。结果与结论:①目前在临床应用中,对于获取动态对比增强MRI图像的最佳扫描方法和分析这种图像的理想方法普遍缺乏共识,其参数分析方法主要是定性、半定量和定量分析3种;②动态对比增强MRI已被广泛应用于心力衰竭、乳腺癌、前列腺癌、肾排斥反应和肝肿瘤等不同疾病的非侵入性检测、定性和治疗监测等,在骨科临床的应用还不够成熟,但具有无限的潜力:其可以用于评估股骨颈骨折后的血运情况及预测股骨头的存活能力、骨折后骨不连的区域灌注情况,关节炎等实体的骨灌注及畸形血管的检测;与常规成像相比,动态对比增强MRI还可以更好地评估不同阶段腰椎灌注变化及椎间盘退变与终板灌注的关系。

BACKGROUND:Although traditional plain scan and enhanced magnetic resonance imaging has been used for skeletal muscle imaging for many years,it is not enough to evaluate the microscopic changes of diseased tissue or the activity of diseased tissue.Dynamic contrast-enhanced magnetic resonance imaging can capture this information and advantages are shown in orthopedic imaging examination.OBJECTIVE:To review the progress of dynamic contrast-enhanced magnetic resonance imaging in orthopedics clinics.METHODS:The relevant documents from January 1900 to February 2020 were retrieved in the CNKI database,PubMed database,Web of Science and Wanfang database by computer.The search terms were“dynamic contrast-enhanced magnetic resonance imaging;skeletal muscle tumor;arthritis;spine;fracture”in Chinese,and“dynamic contrast enhanced magnetic resonance imaging(DCE-MRI);osteomuscular tumor;arthritis;spinal surgery;fracture”in English.RESULTS AND CONCLUSION:(1)At present,there is a general lack of consensus on the best scanning method for acquiring dynamic contrast-enhanced magnetic resonance imaging images and the ideal method for analyzing such images in clinical applications.The parameter analysis methods are mainly qualitative,semi-quantitative and quantitative analysis.(2)Dynamic contrast-enhanced magnetic resonance imaging has been widely used in non-invasive detection,qualitative and therapeutic monitoring of different diseases such as heart failure,breast cancer,prostate cancer,renal rejection and liver tumors.The clinical application in orthopedics is not mature enough,but has unlimited potential:It can be used to assess the blood flow after femoral neck fracture and to predict the viability of the femoral head,the regional perfusion of nonunion after fracture,bone perfusion of arthritis and other entities,and detection of deformed blood vessels.Compared with conventional imaging,in contrast,dynamic contrast-enhanced magnetic resonance imaging can also better assess the relationship between changes in lumbar spine perfusion,disc degeneration,and endplate perfusion at different stages.